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 Folic acid in pregnancy may reduce risk of baby heart defects
Source: Guardian.co.uk Date: 05/15/09
Taking folic acid in early pregnancy is known to reduce the risk of spina bifida and related birth defects. Now, a new study has linked this nutrient to a lower
risk of serious heart defects.
What do we know already?
Folic acid is a B vitamin that is essential for the healthy development
of the neural tubes, which eventually become a baby's brain and spinal
cord. If these tubes don't develop properly in early pregnancy, a baby
can be born with defects such as spina bifida, in which the bones of
the spine do not come together properly.
Women in the UK are advised to take supplements of folic acid when
they're trying to conceive and in early pregnancy. Some countries,
including the US and Canada, also require that folic acid be added to
pasta, bread and other grain products, as not all would-be mothers get
enough of this nutrient. The UK has not taken this step, because of
concern that in elderly people, high levels of folic acid may actually
lead to a deficiency in another B vitamin, B12.
As a result of campaigns to boost women's intake of folic acid in the
UK and abroad, the number of babies with neural tube defects has
declined. Now researchers are looking at whether increasing women's
folic acid intake might also reduce the risk of congenital heart
disease.
Congenital heart disease is the most common type of birth defect. It
happens when one or more parts of the heart or blood vessels don't form
properly. These defects can range from mild problems that may go
undetected for years, to severe defects that cause serious problems or
even death before or soon after birth.
In the new study, researchers looked at the number of babies born with
these problems before and after folic acid was added to grain products
in Quebec, Canada.
What does the new study say?
Using government databases, researchers tracked serious heart defects
among babies in the nine years before folic acid was added to grain
products in 1998, and in the seven years after. They found little
variation in the annual rates of serious heart problems before folic
acid was added, with around 1.64 babies in every 1,000 having these
defects. In the years following, however, there was a 6 percent
decrease, with serious heart defects affecting 1.47 babies in every
1,000.
This may not seem like a very big decline, but the researchers point
out that treatment for heart defects in babies is very complex and
carries a high risk of death, so even a small reduction in risk is
important, as this lessens the emotional toll on families and the
financial costs of care.
How reliable are the findings?
This is the first large study to look at folic acid and heart defects,
and it was reasonably well done. But this type of study can't tell us
for certain that increasing women's folic acid reduces the risk of
serious heart defects. It can show only that there may be a link. This
is because there could have been other factors that led to a drop in
heart defects. For example, these defects are increasingly being
detected in the womb, and some parents choose to end pregnancies as a
result. This could mean fewer babies are born with these heart problems.
Still, the researchers say that the connection between folic acid and
serious heart defects appears to be strong, as the decline in defects
directly coincided with the addition of folic acid to grain products.
They also point out that the decline in heart defects occurred despite
a gradual increase in factors known to raise the risk of these
problems, such as women being very overweight or older when they become
pregnant.
The study didn't look at whether there was a link between folic acid
and less severe heart defects, or at how taking folic acid tablets
might affect the risk of these defects.
Where does the study come from?
The study was done by researchers with Canadian universities and was
funded by the Heart and Stroke Foundation of Canada and the Fonds de la
Recherche en Sante du Quebec. It was published in the British Medical
Journal (BMJ), which is owned by the British Medical Association.
What does this mean for me?
Since folic acid isn't added to grain products here, the study's
findings don't directly apply to women in the UK. But they do suggest
that folic acid may play a role in a baby's heart development, which
may be of interest to you if you are pregnant or hoping to become
pregnant.
What is known is that taking folic acid in early pregnancy does reduce
the risk of spina bifida and other neural tube defects. In the UK,
doctors recommend that most women take 400 micrograms of folic acid
daily while trying to conceive and through the first 12 weeks of
pregnancy. Women at risk of having a baby with a spinal cord problem
are advised to take a higher dose.
What should I do now?
If you're trying for a baby or are up to 12 weeks pregnant, make sure
you're taking a supplement with the recommended amount of folic acid.
From:
Ionescu-Ittu R, Marelli AJ, Mackie AS, et al. Prevalence of severe
congenital heart disease after folic acid fortification of grain
products: time trend analysis in Quebec, Canada. BMJ. 2009; 338: 1673.
© BMJ Publishing Group Limited ("BMJ Group") 2009
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