Folate fortification and supplementation--are we there yet?

Area of Science:

• Public Health
• Nutritional Science
• Obstetrics

Background:

• Folic acid fortification of flour has reduced neural tube defects (NTDs).
• Assessing red blood cell (RBC) folate levels in women of child-bearing age is crucial for NTD prevention.
• Ontario's fortification program effectiveness requires ongoing evaluation.

Purpose of the Study:

• To determine if women of child-bearing age in Ontario have adequate RBC folate levels for NTD prevention.
• To evaluate the impact of folic acid fortification on folate status in the target population.

Main Methods:

• Retrospective review of laboratory data on RBC folic acid levels.
• Analysis included demographic and clinical data (age, gender, hemoglobin, MCV, pregnancy test).
• Focus on non-anemic, normocytic females aged 14-45; NTD protection defined as RBC folate >900 nmol/L.

Main Results:

• In 2006, 40% of women of child-bearing age had RBC folate below 900 nmol/L.
• 36% of pregnant women in the study period had suboptimal RBC folate levels (<900 nmol/L).
• A significant proportion of women remained sub-optimally protected against NTDs.

Conclusions:

• A substantial percentage of pregnant women in Ontario are at risk for NTDs due to inadequate folate levels.
• Recommendations include increasing mandatory folic acid concentrations in flour.
• Public education and enhanced folic acid content in prenatal supplements are also advised.