What Is the Association Between Folic Acid (Vitamin B9) and Neural Tube Defects

What Is the Association between Folic Acid (Vitamin B9) and Neural Tube Defects?

• Folic acid is involved in the one-carbon metabolism that supports the conversion of homocysteine to methionine and prevents the accumulation of homocysteine in the fetal brain. The buildup of homocysteine, a known neurotoxin, in the brain increases the risk of neural tube defects.

• Sufficient dietary intake of folic acid during gestation prevents neural tube defects. Women who gave birth to infants with neural tube defects were found to have folic acid deficiency during gestation. But the neural tube is formed at 28 days after conception, and the majority of women could not even have known that they were pregnant during that first month of pregnancy. Even if they had known that they were pregnant near the end of the first month of pregnancy, it could have already been too late to supplement with folic acid. As such, it is recommended that women consider taking folic acid supplements before conception.

• Many countries have mandated food manufacturers to fortify certain food items—such as cereals, bread, and flour—with folic acid to prevent neural tube defects.

Meta-analysis

• Folic acid (vitamin B9). A meta-analysis of 123 research papers evaluated the relationship between folic acid fortification and neural tube defects. The analysis confirmed that the fortification of folic acid in foods such as bread and flour reduced the incidence rate of neural tube defects.

• Folic acid (vitamin B9). Five research papers explored the association between supplementation with folic acid in women of various races before gestation and the incidence rate of neural tube defects in infants in England. The meta-analysis has shown that European women gave birth to fewer infants with neural tube defects compared to Asian or Hispanic women. In these studies, European women were found to be more likely to follow the instructions to take daily folic acid supplements compared to Asian or Hispanic women.

Recommendation

• Prevention. For women at risk of having babies with neural tube defects, take daily 400 mcg vitamin B9 (8).

• Prevention. For pregnant women, before getting pregnant and during pregnancy, take daily 800 mcg vitamin B9 (8).

Neural tube defects are a collection of malformations of the brain and spinal cord during gestation. Under normal conditions, the neural tube of an infant is formed at 28 days after conception. A neural tube defect, characterized by the exposure of the brain and spinal cord, is a malformation of the neural tube. The majority of infants with neural tube defects die either in the womb or right after birth. The few that survive after birth often have multiple organ failure problems and live short lives. In the US, 1 in 1,000 new babies develops a neural tube defect. Globally, 300,000 infants are afflicted with neural tube defects every year.

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