Folic acid in pregnancy: protects infants from the risk of congenital heart malformations
Folic acid in pregnancy: protects against the risk of congenital heart malformations
Folic acid, a vitamin known for its ability to reduce the risk of occurrence of congenital malformations such as spina bifida, would also appear to be able to prevent certain heart abnormalities in newborns. Specifically, women who consume folic acid-enriched foods during pregnancy are 11 percent less likely to give birth to babies with congenital heart defects.
This was demonstrated by a study conducted by researchers at the University of British Columbia in Vancouver, Canada, whose findings were published in the journal Circulation.
Folic acid and folate: essential for the health of newborns
Folic acid, (or vitamin B9) is a vitamin that performs several important functions in the body; in particular, it is involved in DNA synthesis, amino acid metabolism, and the formation of hemoglobin and thus red blood cells; it also reduces levels of homocysteine, a molecule that in excess is associated with the risk of cardiovascular disease and heart attacks. Because of its functions, folic acid is essential for all cells in the body, particularly those that need to reproduce or renew themselves, such as skin, hair, nail, and blood cells, but especially those in embryonic and newborn tissues during organ development and growth. For this reason, needs for folic acid are greatly increased during pregnancy, growth, lactation, and during special health conditions. Folic acid supplementation is very important in the early stages of pregnancy because it can reduce the risk of fetal malformations, particularly neural tube defects such as spina bifida and anencephaly. In addition, folic acid deficiency can lead to megaloblastic anemia, growth retardation, memory impairment, early graying of hair, and is often associated with deficiency of other nutrients such as vitamin B12 and zinc.
The term folate refers to a group of substances naturally present in foods, with structures and properties similar to folic acid. The foods richest in folate are mainly green leafy vegetables, citrus fruits, eggs, offal, and cereals. It is essential, therefore, that women of periconceptional age get the right amount of folate; but often, diet alone is not sufficient to provide it, and such deficiency can be dangerous for the fetus, as explained in this article. This is why most women of childbearing age take, or should take, folic acid supplements to ward off the risk of birth defects. In 2014, the European Food Safety Authority (EFSA) approved the use of supplements containing 400 micrograms of folic acid, for all women of childbearing age.
Folic acid in fortified foods: only a few countries use it
In some countries, such as Canada, to ward off folic acid deficiency, the production of foods, such as cereals, pasta, and cornmeal, fortified with folic acid was approved and became mandatory in November 1998. In Europe, food fortification has been and is the subject of much debate. The United Kingdom has approved fortification, voluntary rather than mandatory, for wheat flour. This topic had been discussed as early as the 1990s when research conducted by the Medical Research Council had shown that the use of folic acid was associated with up to a 72 percent reduction in neural tube defects.
Currently, the UK Council for Responsible Nutrition, a nonprofit association representing the dietary supplement industry, has not endorsed mandatory fortification of flours because it would go to include the entire population by altering their diets, as opposed to the use of supplements, which instead offers a targeted and voluntary strategy especially for women. Ireland introduced voluntary fortification of foods with folic acid, but over time the number of fortified foods has decreased, and cases of neural tube defects have increased. In Switzerland, about 250 foods are voluntarily fortified with folic acid. In Italy, only voluntary fortification is allowed, following European regulations, and it mainly concerns breakfast cereals, cookies and early childhood products.
Folic acid also reduces congenital heart defects
The new research, published in Circulation, was conducted in Canada, and showed that for women who had consumed foods fortified with folic acid during gestation, the risk of giving birth to children with congenital heart defects was 11 percent lower, compared with women who had not included them in their diets. The association between dietary fortification with folic acid and reduced prevalence of heart defects was found for only a few types of malformations: conotruncal defects, narrowing of the aorta, and to a lesser extent for cardiac septal defects.
Prior to this study, folic acid has been researched several times, highlighting its effectiveness in also preventing congenital heart defects in newborns. These malformations affect about 1 percent of newborns and account for nearly one-third of infant deaths caused by congenital anomalies. A Hungarian study showed that babies born with cardiovascular abnormalities was reduced among women who had consumed multivitamin supplements containing folic acid, compared with women who had consumed only trace element supplements. However, other research on the topic has shown inconsistent results on the effectiveness of fortification and multivitamins containing folic acid with respect to the incidence of heart defects.
The details of the study
The research was conducted on a population of 5,901,701 women with children born, after at least 20 weeks' gestation, in Canada between 1990 and 2011. After controlling for variables such as maternal age, diabetes mellitus, preeclampsia, twin birth, and termination of pregnancy, the effect of food fortification on cardiac malformations was studied on approximately 67,000 births. Among them, there were 72,591 cases of disease diagnosed at birth and in early childhood.
The researchers compared the number of these malformations before and after 1998, which is the year food fortification was approved. The team of researchers found that the prevalence rate of heart malformations was 12.3 per 1,000 children born, with a decrease over the years, with the exception of atrial septal defects, which were shown to increase. The beneficial effects of folic acid were evident for some types of cardiac malformations; in particular, an association was found between consumption of the fortified foods and a 27% reduction in heart outflow tract abnormalities, 23% reduction in aortic narrowing, 18% reduction in atrial defects, and 15% fewer atrial septal malformations. Overall, dietary fortification with folic acid was associated with an 11% reduction in congenital heart malformations.
Can consumption of folic acid supplements prevent congenital heart defects?
Although food fortification with folic acid has been done in some countries primarily to reduce neural tube defects, this study shows that it may have a positive effect on some specific types of congenital heart defects, which are quite common. According to Dr. Joseph, author of the study and professor in the Department of Obstetrics and Gynecology at British Columbia, women who know they may be getting pregnant should start taking folic acid supplements, as they may not necessarily be getting adequate folate from their diet. In addition to foods that contain good amounts of folate, folic acid can be introduced through supplements.
For example, Vita DHA Materna is a dietary supplement produced by Omegor based on DHA and folic acid, ideal in the pre-conception period as well as during pregnancy and lactation. Each tablet of the product contains as much as 250 mg of Omega 3 DHA in its best absorbable form, and 400 mcg of folic acid in the form of L-methylfolate glucosamine salt (Quatrefolic®) the active and most bioavailable form of folic acid. Just take 1 pearl a day to contribute to the proper development of the fetus and the maintenance of the mother's health.
Source: K.S. Joseph et al. "Effect of Folic Acid Food Fortification in Canada on Congenital Heart Disease Subtypes." Circulation
