All Irish women of childbearing age need to take folic acid daily even if a baby is the last thing on their mind, a report by the Food Safety Authority of Ireland (FSAI) has found, as by the time women find out they are pregnant it could be too late.
The 83-page report highlighted that taking folic acid supplements in the first four weeks of pregnancy can prevent up to 70 per cent of certain severe birth defects, including spina bifida and anencephaly, of which Ireland has some of the highest incidence rates in the world.
“A baby’s crucial neural tube develops in the first few weeks of pregnancy when many women may be unaware they are pregnant,” Mary Flynn, chief specialist in public health nutrition at the FSAI, said.
“The low folate status of women of childbearing age remains a significant problem in Ireland, contributing to an unacceptably high rate of neural tube defects,” she said.
Neural tube defects (NTDs), including spina bifida, anencephaly and related defects, are the most common major malformations of the central nervous system. About 80 babies are born every year in Ireland with NTDs. One in three cases is genetic and could not be prevented by taking folic acid.
The recommended dosage for women is 400 micrograms per day. Folic acid is a B vitamin, which is found in broccoli, asparagus, egg yokes and liver. “We warn women not to just rely on folic acid from food. Often the food goes off, is boiled or, in the case of vegetables, bruised and mouldy thus making it less effective,” Dr Flynn said.
The report proposes the mandatory fortification of bread or flour in Ireland to provide about 150 micrograms of folic acid per day for women of childbearing age. “It’s not the same as 400 micrograms but we found that one in five young women in Ireland do not consume folic acid at all. Very few of these women have the level of blood folate required to protect against the development of NTDs should they become pregnant,” she said.
Fortifying flour or bread would require legislation, which could take several years. Voluntary fortification occurs in some cereals, milk and cereal bars. Folic acid in food is not dangerous for men or children. The FSAI suggests putting the doses in certain breads, but not all. “There are issues around mandatory legislation, like putting it into bread, when you take in to account that a lot of women don’t eat bread or more people are on gluten-free diets, so we have yet to decide,” Dr Flynn said.
If taken in large quantities — above 1,000 micrograms — folic acid can be dangerous for elderly people but such an overdose would be difficult to achieve from food.
Studies suggest that the incidence of NTDs may have increased between 2005 to 2006 and 2010 to 2011. The birth defects occur in 0.9 of 1000 pregnancies and many of these end in miscarriage.