New Recommendations May Significantly Reduce Birth Defects in Canada

    OTTAWA, Dec. 12 /CNW Telbec/ - 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
    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.
    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.

    About the SOGC

    The Society of Obstetricians and Gynaecologists of Canada (SOGC) is one
of Canada's oldest national specialty organizations. Established in 1944, the
Society's mission is to promote excellence in the practice of obstetrics and
gynaecology and to advance the health of women through leadership, advocacy,
collaboration, outreach and education. The SOGC represents
obstetricians/gynaecologists, family physicians, nurses, midwives and allied
health professionals working in the field of sexual reproductive health. For
more information, visit

    About Motherisk

    The Motherisk Program at The Hospital for Sick Children is a clinical,
research and teaching program dedicated to antenatal drug, chemical, and
disease risk counselling. It is affiliated with the University of Toronto.
Created in 1985, Motherisk provides evidence-based information and guidance
about the safety or risk to the developing fetus or infant, of maternal
exposure to drugs, chemicals, diseases, radiation and environmental agents.
For more information, visit

For further information:

For further information: Susan Wright, (613) 730-2020; Rhoda Boyd,
(613)798-9138; A backgrounder about these clinical Guidelines is also
available on the SOGC website,

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Society of Obstetricians and Gynaecologists of Canada

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