Folic Acid in Pregnancy: Protects Newborns from the Risk of Congenital Heart Malformations

Folic Acid in Pregnancy: Protects Against Risk of Congenital Heart Defects

Folic acid, a vitamin known for its ability to reduce the risk of congenital malformations such as spina bifida, appears also capable of preventing certain heart anomalies in newborns. In particular, women who consume folic acid-fortified foods during pregnancy have an 11% lower chance of giving birth to babies with congenital heart defects.

This was demonstrated by a study conducted by researchers from the University of British Columbia in Vancouver (Canada), whose results were published in the journal Circulation.

Folic Acid and Folates: Essential for Newborn Health

Folic acid (or vitamin B9) is a vitamin that performs several important functions in the body; it is particularly involved in DNA synthesis, amino acid metabolism, and hemoglobin formation and thus red blood cells. It also reduces homocysteine levels, a molecule which, when elevated, is associated with cardiovascular diseases and heart attacks. Due to these functions, folic acid is essential for all body cells, especially those that need to reproduce or renew, such as skin, hair, nails, and blood cells, but most importantly embryonic and neonatal tissues during organ development and growth. For this reason, the need for folic acid greatly increases during pregnancy, growth, breastfeeding, and certain health conditions. Supplementation with folic acid is very important in the early stages of pregnancy because it can reduce the risk of fetal malformations, particularly neural tube defects like spina bifida and anencephaly. Additionally, folic acid deficiency can cause megaloblastic anemia, growth retardation, memory disorders, premature graying of hair, and is often associated with deficiencies in other nutrients such as vitamin B12 and zinc.

The term folates refers to a group of substances naturally present in foods, with structures and properties similar to folic acid. Foods richest in folates include leafy green vegetables, citrus fruits, eggs, offal, and cereals. It is therefore essential that women of childbearing age consume the right amount of folates; however, often diet alone is insufficient to ensure this, and such deficiency can be dangerous for the fetus, as explained in this article. For this reason, most women of childbearing age take, or should take, folic acid supplements to prevent the risk of congenital malformations. In 2014, the European Food Safety Authority (EFSA) approved the use of supplements containing 400 micrograms of folic acid for all women of childbearing age.

Folic acid in fortified foods: only a few countries use it

In some countries, such as Canada, to prevent folic acid deficiency, the production of foods such as cereals, pasta, and cornmeal fortified with folic acid became mandatory in November 1998. In Europe, food fortification has been and remains a subject of much debate. The United Kingdom approved voluntary, non-mandatory fortification for wheat flour. This issue was already discussed in the 1990s when research by the Medical Research Council showed that folic acid use was associated with up to a 72% reduction in neural tube defects.

Currently, the UK’s Council for Responsible Nutrition, a non-profit association representing the supplement industry, has not approved mandatory flour fortification because it would affect the entire population by changing their diet, unlike supplements which offer a targeted and voluntary strategy especially for women. Ireland introduced voluntary fortification of foods with folic acid, but over time the number of fortified foods decreased, and cases of neural tube defects increased. In Switzerland, about 250 food products are voluntarily fortified with folic acid. In Italy, only voluntary fortification is permitted, following European regulations, mainly involving breakfast cereals, biscuits, and baby products.

Folic acid also reduces congenital heart defects

The new research published in Circulation was conducted in Canada and demonstrated that for women who consumed folic acid-fortified foods during pregnancy, the risk of giving birth to children with congenital heart defects was 11% lower compared to women who did not include these foods in their diet. The association between folic acid food fortification and reduced prevalence of heart defects was found only for certain types of malformations: conotruncal defects, aortic stenosis, and to a lesser extent atrial septal defects.

Before this study, folic acid had been the subject of several researches highlighting its effectiveness in preventing congenital heart defects