Despite folic acid no decrease in neural tube defects in unborn children in Europe

Neural tube defects (such as spina bifida or anencephaly) occur as frequently in Europe as they did 20 years ago. This is what Hermien de Walle, a researcher at the UMCG, discovered together with researchers from all over Europe. The discovery is surprising, because it has been known since 1991 that if women take folic acid before and during pregnancy the chance their baby will have a neural tube defect drops by 72%. The researchers publish their results today in British Medical Journal.

Neural tube defects are a common disorder with serious consequences for the baby’s health and family life. When it was proven in 1991 that folic acid reduced the chance of neural tube defects in children, governments worldwide advised women who were fertile and able to have children to take folic acid.

In the United States this recommendation did not reduce the incidence of neural tube defects. The American government therefore decided to fortify various grain products, such as bread, rice and pasta, with folic acid. Eighty countries around the world have since adopted a similar approach, which means that all women there now consume folic acid. Research has shown a significant reduction in the incidence of neural tube effects in these countries.

In the article that is published in BMJ today, the researchers show that the recommendation that women take folic acid has not had sufficient effect in Europe either. The number of children that are actually born with neural tube defects has dropped, but that is because pregnancies are more likely to be terminated nowadays. It may be that the recommendations do not help because many pregnancies are unplanned, and women who are not planning to become pregnant do not take folic acid.

In the article, the researchers suggest that Europe should also consider a policy of folic acid fortification of food, because recommendations and voluntary intake seem to have little effect. Given the positive results of this policy in many other countries in the world, this is a cheap and effective way to prevent neural tube defects in embryo development. However, before food can actually be fortified with folic acid, the long-term effects of such fortification must be studied.

Hermien de Walle was awarded her PhD degree in 2001 for a study of knowledge about and use of folic acid. As head of EUROCAT (Eurocat Research Group for Congenital Anomalies) she was responsible, together with others, for the data collection in this study.