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Folic Acid/Folic Acid-Containing Multivitamins and Primary Prevention of Birth Defects and Preterm Birth

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Preventive Nutrition

Part of the book series: Nutrition and Health ((NH))

Abstract

The deficiency or overdosage of certain nutrients may have a role in the origin of birth defects. First, in 1932, Hale (1) demonstrated that a vitamin A-free diet during early pregnancy of sows resulted in offspring without eyeballs, oral clefts, accessory ears, malposition of the kidney and defects of hind legs. Hale’s conclusion was “the condition is illustrative of the marked effect that a deficiency may have in the disturbance of the internal factors that control the mechanism of development”. Further development of experimental teratology became possible when small rodents were introduced for this purpose. Joseph Warkany (1902–1992), one of the founders of teratology, recognized the importance of purified diets and used these to test various vitamin deficiencies for their teratogenic effects. Warkany (2,3) found that maternal dietary deficiency can induce structural birth defects, i.e. congenital abnormalities (CAs). Marjorie M. Nelson (4) introduced the use of antimetabolites which made possible conversion of long-term nutritional experiments into short-term chemical testing. First, antimetabolites of folic acid were used and folate deficiency was proven to be highly teratogenic in pregnant rats (5–7), producing multiple CAs, neural-tube defects, orofacial clefts, and other CAs. Later the teratogenic effect of 4-aminopteroylglutamic acid (aminopterin), a folic acid antagonist, was confirmed in man (8–10) as well. Recently the human teratogenic effect of some other folic acid antagonist drugs, e.g. trimethoprim has been shown (11,12).

Key Points

• Neural-tube defects are preventable by periconceptional folic acid or folic acid-containing multivitamin supplementation.

• The incidence of some other structural birth defects, i.e. congenital abnormalities of the heart, urinary tract, and limbs can also be reduced by folic acid-containing multivitamin use during the periconceptional period.

• All women of childbearing age who are capable of becoming pregnant should consume folic and/or a folic acid-containing multivitamin daily during the periconceptional period.

• The primary prevention of neural-tube defects and some other congenital abnormalities by periconceptional folic acid/multivitamin supplementation is much better than the so-called secondary prevention, i.e. the termination of pregnancy after the prenatal diagnosis of severe fetal defects.

• The rate of preterm birth can be reduced by the high dose of folic acid in the third trimester of pregnancy.

• Periconceptional care—beyond other benefits—is optimal for the introduction of periconceptional folic acid/multivitamin supplementation.

• Food (flour) fortification is the most practical means of supplementation of folic acid and other vitamins for all women.

• Proper preparation for conception is the earliest and most effective method for the prevention of birth defects.

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  1. Foundation for the Community Control of Hereditary Diseases, Törökvész lejtő, 32, H-1026, Budapest, Hungary

    Andrew E. Czeizel

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    Adrianne Bendich

  2. Inst. Human Nutrition, Columbia University, West 168th St. 630 , New York, 10032, U.S.A.

    Richard J. Deckelbaum

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Czeizel, A.E. (2010). Folic Acid/Folic Acid-Containing Multivitamins and Primary Prevention of Birth Defects and Preterm Birth. In: Bendich, A., Deckelbaum, R. (eds) Preventive Nutrition. Nutrition and Health. Humana Press. https://doi.org/10.1007/978-1-60327-542-2_25

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