Women of childbearing age should increase their intake of folic acid to five milligrams a day to protect against common birth defects, according to new Canadian guidelines.

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Women who are thinking of becoming pregnant or who are pregnant often require additional supplementation of folic acid. Adequate folic acid is important for pregnant women because it has been shown to prevent some kinds of birth defects, including neural tube defects such as spina bifida. Many foods are now fortified with folic acid to help prevent these kinds of serious birth defects.

That is 10 times the level in standard multivitamins and five times that in most prenatal vitamins, but experts say the change reflects the latest science. Boosting intake, even among women who are not planning to get pregnant, could sharply reduce the rate of devastating birth defects such as spina bifida, congenital heart disease and childhood cancers such as neuroblastoma.

"A lot of this heartache can be very easily prevented," said Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. "Women just need to take multivitamins containing a little more folic acid."

The guidelines, issued jointly by the SOGC and Motherisk and published in today's edition of the Journal of Obstetrics and Gynaecology of Canada, also call for higher levels of folic acid to be added to commercial food products.

Canada has long been a leader in the area of cutting birth defects, and its program to fortify foods and promote folic acid supplementation has been copied worldwide. Since 1998, Canada has had mandatory fortification of white flour, enriched pasta and cornmeal.

The new guidelines recommend that levels of folic acid in these products be
increased to 300 milligrams for each 100 grams, up from the current standard of 140 milligrams.

Folate, or vitamin B9, is found in leafy green vegetables such as spinach, in
legumes such as chickpeas and fruits such as oranges. The synthetic version, folic acid, is added to commercially prepared grain products and sold in the form of

Currently, the recommended daily allowance is 0.4 milligrams, and one milligram for women of childbearing age.

But research has shown that the majority of women are not getting enough folic acid from their diet and supplements to protect their babies, said Gideon Koren, director of the Motherisk program at Toronto's Hospital for Sick Children.

"Five milligrams will prevent 90 to 95 per cent of spina bifida and a lot of other malformations," he said.

But the new guidelines, which are aimed at doctors, midwives, pharmacists, sex educators and public-health officials, recommend that all women of childbearing age take the supplements even if they are not planning to get pregnant.

That is because almost half of pregnancies are unplanned, and folic acid is essential in the first month after conception - when many women are not yet aware they are pregnant - as the neural tube (which later becomes the spinal cord) forms in the embryo.

While the guidelines apply to everyone, they note that there are women who are at particularly high risk of having children with birth defects, and that they should be singled out for counselling.

They include obese women, diabetics, substance abusers and those who have no consistent birth control. Particular attention should also be paid to those who cannot consume grains, such as women with celiac disease, or who adhere to low-carbohydrate regimens such as the Atkins diet.

About 5 per cent of babies in Canada are born with serious congenital abnormalities.

The rate of neural tube defects such as spina bifida has fallen by half since fortification began.

The new guidelines suggest that by bolstering folic acid use, that rate could be cut in half again.

"There's no question we've made a lot of progress in Canada, but it's time to take this to the next level," Dr. Koren said.

He said there is a growing of body of research showing that adequate folic acid levels, in addition to reducing spina bifida, can also prevent some forms of childhood cancer, heart defects, limb deformities, cleft palates, urinary-tract malformations and hydrocephalus.

The easiest way to get adequate folic acid is to take a supplement, he said.

Most prenatal vitamins contain one milligram of folic acid, but one, PregVit folic 5, a product of Duchesnay Inc. of Montreal, has five milligrams.

"You can also buy five-milligram tablets of folic acid. They're pretty cheap and they're worth it for your baby," Dr. Koren said.