While 1 in 4 Canadians aren't aware of folic acid benefits, the supplement is a critical piece in reducing the risk of babies being born with deficiencies, research says
Folic acid is a simple, over-the-counter vitamin that can play a critical role in preventing congenital abnormalities. Despite that, awareness and consistent use of the supplement has remained stagnant, particularly among certain demographic groups in Canada, new research released by the University of Toronto and Mount Sinai has found.
Folic acid, a B9 vitamin also known as folate, is crucial for the healthy development of a baby's brain and spinal cord during the earliest stages of pregnancy - a time when many women are unaware they have conceived. Additionally, deficiencies in this nutrient have been linked to neural tube defects like spina bifida, as well as other congenital abnormalities.
Using the Canadian Community Health Survey (CCHC) as a reference point, Vrati Mehra, a fourth-year medical student at U of T and Dr. Claire Jones, a Mount Sinai fertility and associate professor at the University of Toronto, found that one in four women of reproductive age are unaware they should be taking folic acid before and during pregnancy. Dr. Jones asserts taking folic acid is a critical piece in reducing the risk of babies being born with deficiencies.
“It’s a really terrible condition and Canada's always been known to be at risk for babies being born with these conditions,” says Dr. Jones. “It was identified quite a long time ago to be a significant problem that we had folic acid deficiency in Canada and that was leading to higher rates of these neural tube defects.” She explains this led to fortifying foods in the country in 1998 as part of a public health effort aimed at reducing these deficiencies.
At the time, awareness campaigns helped drive home the importance of supplementation, particularly for women of reproductive age. Now, many food products in Canada have been fortified with folic acid. Pastas and grains have been fortified as have green leafy vegetables, notes Mehra. But if Dr. Jones and Mehra’s study highlights anything new, it’s that one in four women are still unaware that folic acid should be taken before pregnancy. They suggest it should be taken ideally three months in advance.
"If you start taking folic acid after finding out you're pregnant, you’ve already missed that critical window,” Mehra explains, as taking folic acid beforehand allows blood levels to rise to the level that’s needed for a woman to be supporting a new baby. “If you start taking folic acid before pregnancy, and get yourself ready for a potential pregnancy, then you ensure that you're protecting your baby in that first critical month.”
According to data in the study, while 77.9 per cent reported being aware of the benefits of folic acid supplementation, 22.1 per cent of participants reported not being aware. Even fewer (57.7 per cent) of women reported taking FA prior to becoming pregnant. This has led to stagnant levels around 77 per cent for the last decade, with certain groups disproportionately affected.
Mehra highlights those who are socioeconomically disadvantaged, low education levels, new immigrants, and single individuals are less likely to know about folic acid's benefits. “We also found that people who did not have access to a regular healthcare professional, like a family doctor, were also more likely to be unaware,” notes Mehra.
For plan sponsors, the affordability of folic acid further strengthens the case for making it more accessible in benefits plans as Dr. Jones and Mehra highlight a bottle of 100 tablets, roughly a three-month supply, costs just $12. Still, for many, the out-of-pocket expense can act as a barrier. Both agree that incorporating folic acid into health benefits plans could be a game-changer.
“It’s not an expensive medication,” says Dr. Jones. “A drug plan should cover folic acid for any reproductive age woman because many people don't know that they're pregnant until it's late in the game so all reproductive age woman should be taking folic acid.”
Beyond neural tube defects, folic acid has additional benefits, such as reducing risks of congenital heart defects, limb abnormalities, and genitourinary issues. For folic acid to be effective though, women need to have sufficient levels in their system before conception. Supplementation, even at minimal doses, can make a significant difference. Dr. Jones notes for the average woman, the recommended dose is 400 micrograms daily. However, those with complicated medical conditions or those who are already on medications, particularly for mental health, Dr. Jones adds, should check with their physician about what dose they would be recommended.
“It would be so nice if people came and asked, ‘What can I do to optimize having a healthy, live birth?’ That’s ultimately what we want,” says Dr. Jones. “To help people achieve, not just becoming pregnant, but having healthy families.”
