There is a decrease in the number of babies born with serious congenital heart defects in Canada, following obligatory enrichment of grain products containing folic acid.
It is common knowledge that the consumption of folic acid prior to conception and in the first months of pregnancy diminishes the risks of spina bifida and other neural tube defects. Although further confirmation is needed, research points out that folic acid may perhaps also help prevent congenital heart disease (the most frequent of all birth defects).
In Canada, flour and pasta products are mandatorily enriched with folic acid since 1998. Researchers evaluated the effects of folic acid fortifications policies based on the frequency of severe congenital birth heart defects in that region. In Europe, mandatory food fortification has not yet been approved. During a sixteen year period from 1990 to 2005, and with the help of administrative data base in Quebec, researchers evaluated every infant alive and stillborn that presented serious heart defects. In order to appraise the variations in the incidence of severe heart defects within the population, records were evaluated twice, before and following fortification. Throughout the period of the research, out of 1.3 million births in Quebec, there were 2,083 infants born with severe heart defects, resulting in an average of 1.57 in 1,000 births. The investigation reported no change in the rate of birth with severe heart defects during the nine years before food fortification. But on the other hand, there was a considerable six percent decrease per year during the seven years after fortification. Additional assessments confirmed that the decreasing trend was a direct result of fortification, consequently sustaining the assumption that folic acid intake at the time of conception is beneficial in reducing the risk of severe congenital heart defects. The timing of the observed effect corresponds precisely with the timing of fortification, hinting that the results are not pure coincidence. Furthermore, there is biological proof of this connection, and nearly all other risk factors known, such as mature maternal age, use of medication, or obesity have steadily augmented in Quebec during the study period.
The authors explain that although the average six percent drop might appear small, it is a significant progress. Heart defect in infants is linked to high mortality rates, difficult treatment, costly medical care and heavy psychological burden on patients and their families. They indicate that in order to truly estimate the exact impact of folic acid and validate these results, further population-based studies are required.
Source: Folic acid fortification and congenital heart disease
Helena M Gardiner, senior lecturer and director of perinatal cardiology
Jean-Claude Fouron, professor of fetal cardiology
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