FOLIC ACID AND PREGNANCY

Recent evidence suggested that folic acid might decrease the birth prevalence of congenital heart defects, the most common of all birth defects.

Believe it or not, the existing evidence for an association between folic acid and congenital heart defects, however, was still inconclusive in 2007—even though doctors have been prescribing it for a long time. This lack of solid evidence even necessitated a statement from the American Heart Association Council which emphasized the importance of this possible association and the need for corroborative evidence from population based studies.

Canadian researchers examined rates of severe congenital heart defects during the 9 years before folic acid fortification of grains was implemented (1990–1998) and during the 7 years afterward (1999–2005).
They found that while the heart defect rate remained stable before fortification, it dropped an average of 6% per year in the period after.
The authors conclude that the data "support the hypothesis that folic acid has a preventive effect on heart defects.”

SUMMARY:

What is already known on this topic
Animal studies show that folic acid might prevent congenital heart defects. Evidence from one randomized controlled trial and several case-control studies is supportive but not conclusive because prior to this study evidence was lacking from from population based studies.

What this study adds

The birth prevalence of severe congenital heart defects in Quebec, Canada, decreased after the implementation of a public health policy to increase the folic acid intake at the population level. This population based study supports previous evidence that intake of folic acid around conception has a preventive effect on congenital heart defects
BMJ 2009;338:b1673

COMMENT: The evidence now is irrefutable. Folic acid must be part of the nutritional supplements taken in pregnancy.


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