Ludhiana, November 22
Sushma, who conceived after eight years of her marriage, was in the seventh heaven. The gynaecologist prescribed a host of multi-vitamins and iron tablets , but when the baby was born, it had no brains and died immediately. Experiments have conclusively proved that folic acid is required before pregnancy and is necessary for neuro-tubal development.

Did you know that taking the vitamin, folic acid, daily worth 10 paisa can reduce the risk of having a baby with a neural-tubal defect by up to 70 per cent? This is one of the main public service announcements currently being given to women in the USA by Dr Ashok C. Antony, a Professor of Medicine at the Indiana University School of Medicine (USA) . Dr Anthony is an internationally recognized authority due to his 22-year-long pioneering research on folate receptors, which mediate the entry of the vitamin folic acid into human cells, and is currently in Ludhiana visiting his alma mater Christian Medical College and Hospital as a Fulbright Scholar.

His message is that folic acid (also referred to as folate) can help prevent birth defects only if taken before pregnancy and during the fist few weeks of pregnancy. This is the meaning of the term ‘periconceptional folate supplementation i.e. taking folate supplements before the woman conceives’, which is the message that Dr Anthony is trying to spread with a missionary zeal.

Folic Acid is needed to produce new DNA (genetic material) as human cells multiply. Without adequate amounts of folic acid, cell division is impaired, leading to poor growth in the foetus and/or placenta, and low blood counts. Earlier research identified that women who were deficient in folic acid during pregnancy were more likely to have a premature baby of low birth weight. Such women were also likely to have repeated early miscarriages. This led to the prevailing practice of giving folic acid when a women conceived. However, in spite of regular folate administration, several babies were born with neurol tubal deficiencies.

The neural tube is the embryonic structure that develops into the brain and spinal cord. This structure, which starts out as a tiny ribbon of tissue, normally folds inward to form a tube as early as the 28th day after conception. Among the NTDs, anancephaly (absent brain and spinal cord) and spina bifida (a condition where there is an opening in the spine through which the spinal cord and nerves can be visible) are the commonest. Other forms of NTDs include encephalocele, meningocele or meningomyelocele, involving herniation (protrusion of the brain and spinal out of its normal position) in the head and spine. However 100 per cent of those with anancephaly are still born or die shortly after birth (most often within hours). Spina bifida exerts a major long term toll with respect to emotional costs to the parent. But for the afflicted child, the actual physical burden of disease with paralysis of both lower limbs and lack of control of bladder and bowel function and other major psychological costs are incredibly high. While most of these children die from infections during childhood, those who survive, often do only as beggars in India.

An obvious question is: Can NTDs be prevented by giving folate earlier, namely, in the periconceptional period? NTDs originate in the first month of pregnancy, before many women even know they are pregnant. Therefore, it is very important for a women to have enough folic acid in her system before conception. In definitive research published in prestigious medical journals the results uniformly concluded that those mothers who had previously given birth to a baby with NTDs and who took 4 milligram of folic acid before they became pregnant, experienced upto 70 per cent reduction in NTDs.

More importantly, when women who had never been pregnant took 1 milligram of folic acid, there was nearly a 75 per cent reduction in the first time occurrence of NTDs. These results suggest that folic acid benefits all women in preventing NTDs.

Preconceptional vitamins use can also reduce the risk of other defects (e.g. cleft-lip and cleft palate), as well as some congenital heart defects, and some rare urinary tract defects. And research has also demonstrated that women cannot get enough folic acid by eating a balanced diet. This has led to the current mandate by the Food and Drug Administration of the USA that common foods (bread, flour, rise, cereals) must be fortified with folic acid.

Given that in India there is much higher prevalence of folate deficiency in many more women in the child-baring age in India, a conservative estimate has it that 10,000 cases of NTDs can be prevented each year in India by supplemental folates. However, a prominent obstetrician in Ludhiana suggests that the true ‘estimates’ NTDs in India may be closer to 50,000 per year.

Is there any concerted effort to reduce the incidence of NTDs in India? The answer is that there is no such organised program of any significance in India. For this reason, Professor Antony believes it is high time that citizens of Punjab take a lead role, “Punjab is well known for its educated and progressively thinking women. My belief is that our women can play a key role in educating one another at the root level. Our job as healthcare professionals is to initiate an informational educational programme, advising them of the risks about and benefits of preventing NTDs with periconceptional folic acid”. The message is simple and worth repeating. “If you are in the childbearing age, you should be taking one milligram of folic acid everyday — before you get pregnant!!!” And if someone has already had an NTD problem, then they need to take 4 milligram of folic acid daily before they get pregnant the next time. Folic acid can help prevent birth defects of the brain and spinal cord only if taken before pregnancy and in the first few weeks of pregnancy. This is one of the cheapest and safest ways to avoid having a baby with a very serious birth defect. Folic tablets area easily available in any chemist shop. The tremendous benefits of this preventive medicine cannot be ignored. Additional resource information can be found on the internet under the following address : http:/www.cdc.gov/ncbddd/folicacid.