Folate fortification law linked to decreased heart defects

After a Canadian law mandating the fortification of flour and pasta products with folate went into effect in 1998, the birth prevalence of severe congenital defects has decreased in Quebec, according to a study published online May 12 in BMJ.

Raluca Ionescu-Ittu, a PhD candidate at McGill University in Montreal, Canada, and colleagues analyzed 1990 to 2005 data on over 1.3 million births, including 2,083 infants born with severe congenital heart defects, and conducted a time trend analysis.

During the 9 years before the fortification law went into effect, the researchers found that the birth prevalence of severe congenital heart defects remained stable (rate ratio, 1.01). However, in the 7 years after the law was enacted, they found that the prevalence declined by 6% per year (rate ratio, 0.94).

"Mandatory food fortification has reduced the prevalence of neural tube defects by about 9%, and Ionescu-Ittu and colleagues describe modest reductions in congenital heart disease," states the author of an accompanying editorial. "Substantial reductions in malformations have been reported only from additional periconceptual supplementation. As the population becomes more obese, rates of type 2 diabetes increase, and nutritional habits remain poor, the prevalence of congenital heart disease may increase. So, rather than considering fortification targeted at populations, should we find more effective interventions to target women of child-bearing age?"

Ionescu-Ittu R, Marelli AJ, Mackie AS, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ. 2009;338:b1673. doi:10.1136/bmj.b1673.