AnemiaBirth DefectsFolic AcidInfantsVitamins

Benefits of folic acid fortification in Canada

It’s associated with a significant reduction in the rate of neural-tube defects (eg, spina bifida) in Canada.

Getting enough folic acid, a B vitamin, before and during pregnancy prevents most neural tube defects.

In 1998, in Canada, where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces, the government mandated folic acid fortification of cereal products.

Here are the results of that decision, as published in The New England Journal of Medicine.

  • The prevalence was 1.58 per 1000 births before fortification
  • It dropped to 0.86 per 1000 births during the full-fortification period — a 46% reduction.
  • Geographical differences almost disappeared after fortification began.
  • The reduction in rate of spina bifida was 53%
  • For anencephaly (absence of part or all of the brain) 38%.
  • For encephalocele (protrusion of brain tissue through the skull) 31%.

The bottom line?
Good for Canada, but don’t start taking folic acid supplements unless you talk to your doctor first.

One of the first things I remember during pharmacy school (I think it occurred during my 4th year) was that folic acid should not be taken to treat undiagnosed anemia because it might hide its symptoms, leading to neurologic damage. Treatment of anemia during folic acid therapy may also require taking vitamin B12.

7/12/07 08:31 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.