Folate and neural tube defects

Current Concerns
• Ireland still has one of the highest rates of incidence of neural tube defects (NTDs) in Europe (0.8 – 1.5 cases per 1,000 births)

• A genetic predisposition for the development of NTDs is prevalent in this country(1)
• The NSIFCS indicated only 2% of women aged 18-35 years and 5% of women aged 36-50 years actually achieved daily intakes to cover their RDA for folate plus the additional 400µg supplement
• 50% of pregnancies are unplanned and when women discover they are pregnant it is already too late
• Folate is not easy to get and is destroyed in cooking
• Folate deficiency can lead to anaemia, cognitive impairment and depression.
Recommendations
• Peri-conceptual supplementation with folic acid has been shown to prevent up to 70% of NTDs
• Since 2006, mandatory fortification of flour is recommended
• The National Committee on Folic Acid Fortification recommends the following to reduce incidence of NTDs: (2)
- All sexually active women of childbearing age should take 400µg folic acid as a supplement.
- Those who fall pregnant should continue to take folic acid until week 12 of pregnancy.
- Natural food sources of folate and foods fortified with folic acid should be consumed daily to meet individual needs (300µg RDA) for folate.
- Women on long-term medication e.g. those with diabetes or on anti-seizure medication are also advised to consult their GP as their requirements for folic acid may be higher.
References:
1- Kirke PN et al. Impact of the MTHFR C677T polymorphism on risk of neural tube defects: case-control study. BMJ. 2004 Jun 26;328(7455):1535-6.
2- Food Safety Authority of Ireland (2006). Report of the National Committee on folic Add fortification. Dublin. www.fsai.ie