Seventy babies are born every year with neural tube defects. Folic acid reduces the risk. This health message should be a compelling one, yet it isn't working. Sylvia Thompson reports.
For some women, it's almost like folic acid fatigue so well do they know that taking folic acid supplements for three months before becoming pregnant and in the first three months of their pregnancy will reduce the risk of their babies developing a neural tube defect such as spina bifida by up to 70 per cent.
But for many others - a recent Irish study of 2,000 mothers found that three out of four pregnant women don't take the recommended 400 micrograms of folic acid daily for the crucial six months - the health message simply isn't reaching them.
For this reason, a new public health campaign launched today will pitch the folic acid message at all women of child-bearing age, from teenagers in schools to women in their 20s and 30 across all socio-economic groups.
"In the past, folic acid was associated with becoming pregnant and, because up to 50 per cent of pregnancies in Ireland are unplanned, we feel it is important to target all women of child-bearing age," says Elaine Boyce, family support worker with the Irish Association for Spina Bifida and Hydrocephalus (IASBAH), which is running the campaign.
Orla Maher Lawlor says: "I have three daughters and my middle daughter has spina bifida. And I am shocked to see that members of my family, friends and other relatives are still not taking folic acid as a preventative measure even though they know a child with a neural tube defect.
"As soon as my girls are menstruating, they'll be getting folic acid daily like a vitamin."
Dr Peadar Kirke, specialist in public health medicine with the Health Research Board, believes the folic acid message is not reaching enough women because we don't have a sustained public health promotion programme on folic acid.
This IASBAH campaign, which has designated November as National Folic Acid Awareness Month, will last for three to four weeks.
"Seventy babies are born every year with neural tube defects. Up to 50 of those babies could have been born normal if we had an effective prevention programme including both supplementation of the diet with folic acid and a folic acid food fortification programme," says Dr Kirke.
Dr Kirke believes this two-pronged approach is necessary to reach out to women who will not take supplements.
"It's very important to take the 400 micrograms of folic acid daily but there will always be women - particularly young mothers, those in socially disadvantaged areas and those with poor levels of education - who will not get the message.
"For these women, mandatory food fortification of food such as breads, pastas and cereals could give them up to between 100-150 micrograms of folic acid a day."
Dr Kirke points to the United States and Canada where mandatory fortification of grain-based products has been in place since 1998.
"Studies from the United States have shown a 20-30 per cent reduction in neural tube defects since the introduction of the mandatory fortification programme while Canadian studies have found over 50 per cent reduction in neural tube defects - the difference is believed to be because the Canadian researchers included terminations of pregnancies in their data whereas that information wasn't available in the US," Dr Kirke says.
In March 2003, the National Food Safety Authority pointed to a potential risk to older people if flour was fortified with folic acid for the prevention of neural tube defects. The risk is that high intakes of folic acid can mask pernicious anaemia which is an early symptom of Vitamin B12 deficiency in older people, thus delaying diagnosis and treatment.
"Prolonged deficiency of vitamin B12 can cause irreversible damage to the nerves and spinal cord, leading to severe disability," the report stated.
However, the same report concluded that "the universal fortification of flour at 200 micrograms per 100g in food products... would have a significant effect in preventing neural tube defects without resulting in appreciable risk of adverse health effects from high intakes in any group of the population."
Just before leaving office as the Minister for Health, Micheál Martin announced the establishment of a national committee on Folic Acid Food Fortification. This committee, which will include representatives from consumer, health and industry groups, is expected to hold its first meeting before Christmas.
"We'd like to see the national committee do its job as efficiently as possible so that mandatory fortification of food can be introduced so there can be more healthy babies born. If you consider in the six years since such mandatory fortification was introduced into North America, we could have 300 normal healthy babies born in this country," Dr Kirke says.
Merits of folic acid
What is folic acid?
It is a synthetic form of naturally occurring B vitamin called folate.
Why do women of child-bearing age need to take a folic acid supplement?
A daily supplement of 400 micrograms of folic acid is recommended for women to reduce the risk of the development of neural tube defects in babies in early pregnancy.
Studies have shown that the risk of neural tube defects can be reduced by 70 per cent when folic acid supplements are taken for three months prior to conception and in the first three months of pregnancy.
What are neural tube defects?
Neural tube defects are abnormalities which occur in the neural tube (the area of the foetus which later develops into the brain, spinal cord and bone surrounding these organs). The most common neural tube defect is spina bifida. In Ireland, the number of babies born with a neural tube defect is approximately 25 per cent higher than in other Western European countries.
Why can't women get enough folic acid from food sources?
According to a Food Safety Authority of Ireland report, the current daily average intake of total folate in women in their reproductive years is about 270 micrograms. This estimate includes folate from food sources (foods high in folate include leafy green vegetables, beans, peas and orange juice) and approximately 70 micrograms of folic acid from fortified foods (such as breakfast cereals, milk and some breads). A total folate intake of 600 micrograms or 400 micrograms of folic acid is recommended for women to reduce the risk of neural tube defects in babies. Women with a family history of neural tube defects are recommended to take 4000 micrograms of folic acid daily.
Does Folic Acid have other health benefits?
Current research is pointing to a role folic acid may have in the prevention of heart disease and stroke. Other studies have found a possible preventative link with colon cancer and possibly some other cancers.