Mandatory Folic Acid Fortification Reduces Heart Defects at Birth

A new study reports that the number of babies born with severe congenital heart defects in Canada has decreased after mandatory fortification of grain products with folic acid.

Researcher at McGill University (Montreal, Canada) assessed the impact of folic acid fortification policies on the birth prevalence of severe congenital heart defects in the province of Quebec (Canada) by time trend analysis. Using administrative databases, the researchers identified all infants (live and stillborn) with severe congenital heart defects in Quebec over a 16-year period (1990 to 2005). The resulting data were analyzed in two time periods--before and after fortification of flour and pasta products with folic acid, mandatory in Canada since 1998--to estimate the change in prevalence of severe heart defects within the population.

During the study period there were 1,324,440 births in Quebec and 2,083 infants born with severe heart defects, corresponding to an average birth prevalence of 1.57 per 1,000 births. The time trend analysis showed no change in the birth prevalence of severe heart defects in the nine years before fortification, while in the seven years after fortification there was a significant 6% decrease per year. Further analysis made little difference to the results, suggesting that the decreasing trend after fortification did not occur by chance, and supporting the theory that intake of folic acid around conception reduces the risk of severe congenital heart defects. The study was published on May 12, 2009, in BMJ.

"An average 6% drop per year may seem modest,” concluded study coauthor Professor Louise Pilote, M.D., Ph.D., and colleagues of the division of general internal medicine. "But, given that treatment for heart defects in infancy is highly complex and is associated with high infant mortality rates, even a small reduction in the overall risk will significantly reduce the costs associated with the medical care of these patients and the psychological burden on patients and their families.”

Folic acid is a water-soluble form of Vitamin B9, essential to numerous bodily functions ranging from nucleotide synthesis to the remethylation of homocysteine. It is especially important during periods of rapid cell division and growth. Both children and adults require folic acid to produce healthy red blood cells and prevent anemia. Folate and Folic acid derive their names from the Latin word folium (leaf), since it is present in leafy vegetables such as spinach, turnip greens, and lettuces, as well as in fresh beans and peas.

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