BIRTH DEFECTS TOTALLY PREVENTABLE

5/26/2004
ANOTHER AVOIDABLE HEALTH CATASTROPHE THAT COULD BE TOTALLY ERADICATED WITH A 10-CENT VITAMIN PILL

It's worse than thalidomide, the anti-nausea drug that caused horrid birth defects among newborn children decades ago.

It strikes more newborns than HIV infection.

It is also completely preventable, yet thousands of babies continue to be born with severe defects that are too horrid to show graphically.

The defects of spina bifida and anencephaly are caused by a shortage of folic acid, a 10-cent vitamin available at any drug store. Yet no more than three in ten American women take folic acid pills that would prevent these birth defects.

Progress noted, but it was really a disappointment

This Mother's Day the Centers for Disease Control issued a press release heralding a drop in the number of these birth defects. The CDC website says: "Great news for Mother's Day! Two serious birth defects in the U. S., anencephaly and spina bifida, are on the decline since fortification of enriched cereal grain products with folic acid."

What the Centers for Disease Control announced was that the estimated number of pregnancies that resulted in two preventable birth defects (spina bifida or anencephaly) dropped by about 26 percent, from 4130 cases in 1995-96 to 3,020 in 1999-2000. This is attributed to fortification of foods with folic acid since 1998.

Sounds great doesn't it? The FDA mandated folic acid food fortification in 1998 and the CDC reports that it worked. The problem is that the 26 percent reduction in birth defects is less than what was estimated from research trials. Public health authorities had hoped for a 50 percent reduction. The food fortification program was a bit of a disappointment. [Morbidity Mortality Weekly Reports, 53; 362-365, May 7, 2004]

Jenny Williams, a nurse epidemiologist in the CDC's national center for birth defects and developmental disabilities, says folic acid intake has increased but that this isn't enough. Another 1000 babies could be born with birth defects annually even if women consume the recommended 400 micrograms of folic acid daily. [Reuters May 6, 2004] Higher doses could eliminate the risk almost totally. This means common vitamin pills that typically provide 400 mcg of folic acid are not up to par.

To make matters worse, within days of the CDC press release a news story revealed that better than 50 percent of the population has an altered copy of a gene that increases their risk of giving birth to babies with these same birth defects. [Reuters May 21, 2004]

Doctor writes a letter

Dr. Darshak Sanghavi, a pediatrician at Children's Hospital and Harvard Medical School, writing in the Boston Globe, says spina bifida does not receive the public attention as have other infant health disasters. Dr. Sanghavi's letter quotes Dr. Robert Brent of Jefferson Medical College as saying "folic acid birth defects are as preventable as polio."

In 1992, when two large studies confirmed that folic acid could reduce these birth defects by 50 to 70 percent, the CDC recommended folic acid pills for all child-bearing women. The FDA however drug its feet and waited till 1998 before mandating folic acid food fortification. Had more timely action to fortify foods with folic acid taken place thousands of birth defects could have been prevented at a cost savings of billions of dollars.

Not enough folic acid

The FDA knew for the past 8 years that their food fortification program would be inadequate. The amount of folic acid the FDA added to foods is tiny --- just 40 micrograms per 3.5 ounces of bread or grain and "alone will probably not meet a woman's need for 400 micrograms each day," says a 1996 FDA bulletin. While the Institutes of Medicine had judged 10 times greater than the 40 microgram amount to be safe, the FDA mandated foods be fortified with only one-fourth the amount of folic acid needed to prevent spina bifida because it was concerned about folic acid masking a deficiency of vitamin B12 in the elderly.

With half of all pregnancies unplanned, women are not likely to be thinking about prevention of birth defects. From 1995 to 2002 the percentage of women taking folic acid supplements rose by only 6 percent (from 25 to 32%). Food fortification is a priority. Public health officials just can't lay blame on fertile women for not taking folic acid pills.

If food fortification of folic acid were set at 1000 micrograms per day (a mere 1 milligram), the risk for these birth defects would drop by an estimated 57 percent and 5000 micrograms by a whopping 85 percent! [Lancet 358: 2069-73, 2001]

Why not fortify both folic acid and vitamin B12? What harm could come of it? The CDC recommends high-dose folic acid, 4000 micrograms, but only AFTER a woman has given birth to a stillborn baby or a baby with a birth defect. [Morbidity Mortality Weekly Reports 1: 1-3, 2002] So obviously the CDC doesn't believe high-dose folic acid is harmful.

Until an adequate food fortification program is put into practice, universal supplementation with folic acid should be advised for all women of child-bearing age, as much as 1000 micrograms daily, accompanied by an ample amount of vitamin B12, 50-300 micrograms. Folic acid supplementation must be practiced prior to conception since these defects occur within the first weeks of pregnancy.