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Motherisk News: New Recommendations May Significantly Reduce Birth Defects in Canada

OTTAWA - December 12, 2007 - As many as half of certain birth defects could be prevented if women of childbearing age consumed an adequate amount of folic acid, either by eating sufficient quantities of food fortified with folic acid or by taking vitamin supplements, according to new Clinical Guidelines released today for Canadian health care professionals.

Produced by a multidisciplinary panel of experts from the Society of Obstetricians and Gynaecologists of Canada (SOGC) and The Motherisk Program at The Hospital for Sick Children, the Guidelines are a new standard for Canada, recommending higher levels of folic acid supplementation with a goal of further reducing the rates of neural tube defects such as spina bifida and possibly some other common birth defects.

According to the Guidelines, which are based on recent research findings that update previous medical knowledge about the link between folic acid and birth defects, some of the most prevalent birth defects could be dramatically reduced if women further boosted their intake of folic acid and multi-vitamins for at least three months before they become pregnant.

"It is hard to see the joy of a pregnancy turn suddenly to shock and sadness as women and their families are told that a birth defect like spina bifida has been identified by routine screening or at birth," says Dr. Gideon Koren, Director of the Motherisk Program, and a senior scientist in the SickKids Research Institute. "The concept that simple vitamins can prevent such tragedies must be explored to its maximum."

The Guidelines state that doctors should recommend folic acid supplementation levels for women planning a pregnancy based upon dietary, health and lifestyle factors. Specifically, to protect the majority of babies from neural tube defects, some women will need 5mg per day of folic acid, rather than the 1mg which is currently included in most prenatal vitamins. The Guidelines also urge the federal government to consider nearly doubling the level of folic acid fortification currently applied to a range of flour products.

New research shows that higher levels of folic acid, in combination with multi-vitamins, will further decrease the incidence of birth defects such as neural tube defects (NTDs) . Further, while previous Guidelines have focused on the benefits of folic acid in terms of preventing NTDs alone, new evidence highlights its potential to reduce the incidence of other birth abnormalities such as congenital heart disease, urinary tract problems, oral facial clefts, limb defects, and some early pediatric cancers.

"The good news is that a lot of this heartache can be very easily prevented ? women just need to take multi-vitamins containing a little more folic acid, and they need to start taking it at least three months before becoming pregnant," says SOGC Associate Executive Vice-President Dr. Vyta Senikas, who notes that the Guidelines will provide guidance to family physicians, mid-wives, obstetricians and gynaecologists across Canada. "For many women, by the time they know they are pregnant, it?s simply too late to reap the full protective benefit of folic acid and multi-vitamin supplements, so we need to get this information out there."

Due to prenatal screening and awareness programming about folic acid supplementation, the birth prevalence of NTDs has declined in Canada from a rate of ten per 10,000 live births in 1991 to 5.8 per 10,000 total births (live births and stillbirths) in 1999. Despite this progress, Dr. Senikas highlights that these very preventable birth defects continue to cause emotional and economic strain for Canadian families and their children, along with additional costs to the national healthcare system.

Folic acid helps produce and maintain new cells, and is important during the early embryonic and fetal periods when rapid cell division and growth are occurring. The authors of the Guideline estimate that as many as half of all birth defects could be prevented if women of childbearing age consumed an adequate amount of folic acid, either by eating sufficient quantities of food fortified with folic acid or by taking vitamin supplements.

The new Guidelines are very specific about how much folic acid women need and that they should start upping their intake before they plan their pregnancies. Unlike previous medical guidance, these Guidelines also differentiate the needs of women based on overall health status. Factors such as age, ethnicity, whether a woman will routinely take vitamins, and previous history of genetic problems or birth defects make a difference in terms of how much folic acid is recommended. Women with compromised health or conditions such as insulin-dependent diabetes are advised to boost their folic acid intake significantly. All women who plan to have children are advised to start their folic acid supplementation early.

The Guidelines are particularly focused on engaging health care professionals so they can raise awareness of the new research and the importance of folic acid supplementation.

"It's challenging to get women to consume folic acid and vitamins before they get pregnant, since about half of all pregnancies are unplanned, and women?s health status may not be optimal when they conceive," says Dr. Senikas.

As a result, the Guidelines include higher levels of folic acid supplementations for selected groups of women. They have further suggested that the federal government look at adding more folate to flour. Since 1998, there has been mandatory folic acid fortification of white flour, enriched pasta, and cornmeal in Canada.

In addition to folic acid and multi-vitamin supplementation, women of childbearing age are advised to maintain a healthy diet, as recommended in Eating Well With Canada?s Food Guide (Health Canada). Foods containing excellent to good sources of folic acid are fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, Brussels sprouts, corn, and oranges. However, it is unlikely that diet alone can provide the levels recommended for those planning to have children.

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