Regular intake of folic acid is recommended for all fertile women. This vitamin, B9, is essential to prevent serious malformations in unborn children. Yet, a large proportion of Italian women still underestimate its importance. Does not take any or does not comply with recommended times and ways of intake. ISS (Istituto Superiore di Sanità) recommendations.
Folic acid and folate, word of mouth
Vitamin B9-naturally found in fruits and vegetables in the form of folate-is essential for DNA and protein synthesis, as well as for the formation of hemoglobin. It also reduces homocysteine, which is associated with the risk of cardiovascular disease and heart attacks.
In conception and pregnancy, B9 then assumes an essential role in preventing serious malformations of the unborn child’s nervous system, such as neural tube defects (e.g., spina bifida) and other congenital abnormalities. (1) Serious events-which still affect 3 percent of newborns-and can, indeed should, be prevented.
Nutrition is not enough to achieve the recommended intake in the early stages of pregnancy, during embryo formation. Supplemental folic acid (the oxidized form of the vitamin) supplementation is therefore essential. (2)
Conception and pregnancy. when and how to take folic acid
The Istituto Superiore di Sanità (ISS) promotes supplemental intake of B9 from at least one month before conception-that is, regularly in women who do not actively rule out pregnancy-until the third month of gestation. As always, as part of a varied and balanced diet.
Drugs that provide folic acid in the recommended supplementary dose (0.4 mg/day) are moreover paid for by the National Health Service (NHS). In fact, only co-payment is due by presenting the ‘red prescription’ issued by the family doctor or a public health facility.
Fortified foods?
In the U.S. and Canada, on the other hand, the goal of generalized supplementation, aimed at the entire population, is pursued through the ‘mandatory fortification’ of wheat flour and some derived products (e.g., pasta). (3) However, this approach does not convince the Italian scientific community.
In fact, fortified foods prevent accurate dosing of total vitamin supplementation. And in cases of overdose–of vitamin B9 in particular, as some studies show–unexpected toxicity may occur. (4) The ISS is forming an interdisciplinary working group on this issue. In order to review the latest scientific evidence and define the best strategy for optimal folic acid intake among women of childbearing age.
Communicating prevention
Communicating the crucial value of periconceptional folic acid supplementation to all women of childbearing age is essential to prevention and public health protection. As reiterated at the conference organized by ISS on 29.11.19,‘Congenital Malformations: from Communication to Prevention, CCM 2018.
Dissemination of recommendations to the population on the preventive effects of folate and folic acid in Italy began around 2000. In those years, only 3-4% of women adhered to the directions given. And it is precisely through appropriate information campaigns that a first appreciable result has already been achieved. In fact, in 2012, folic acid supplementation in the periconceptional period was followed correctly by 25.4 percent of Italian women and 8.2 percent of foreign women residing in Italy. (5)
There is still much to be done. Communication is gaining proselytizers, even among younger segments of the population. The ISS conference was attended by students from the Roberto Rossellini Cine-TV Institute in Rome, who presented their own video aimed at promoting periconceptional intake of folic acid. (6) An initiative all the more useful when young aspiring filmmakers-potential future parents-and their contacts know how to spread the information, including through social networks.
We invite our readers to participate in this valuable information campaign by disseminating this article and its recommendations.
Notes
(1) See the in-depth study of the National Center for Rare Diseases (CNMR) of the ISS.
(2) See the Recommendation of the Italian Folic Acid Promotion Network for the Primary Prevention of Congenital Defects.
(3) ‘“Mandatory fortification” – in English mandatory fortification – is a process that is regulated by an ad hoc state law that, following consultations among panels of experts and assessments of the possible risks-benefits of this choice, obliges the enrichment of a food matrix (often cereal flours with a certain – or certain – nutrient, establishing the doses and methods‘, Stefania Ruggeri – Council for Agricultural Research and Analysis of Agricultural Economics (Crea), Food and Nutrition, What is food fortification?
(4) Dandan Chu, Longfei Li,Yanli Jiang, Jianxin Tan, Jie Ji, Yongli Zhang, Nana Jin, Fei Liu. Excess Folic Acid Supplementation Before and During Pregnancy and Lactation Activates Fos Gene Expression and Alters Behaviors in Male Mouse Offspring. Frontiers in Neuroscience, 2019 https://doi.org/10.3389/fnins.2019.00313
(5) The percentage of women taking folic acid after pregnancy has begun is higher: 70.3 percent of Italian women and 62.6 percent of foreign women residing in Italy. V. Epicenter, the Epidemiology Portal for Public Health .
(6) The video is available on the website of the Alberto Rossellini Cine-TV Institute.
Professional journalist since January 1995, he has worked for newspapers (Il Messaggero, Paese Sera, La Stampa) and periodicals (NumeroUno, Il Salvagente). She is the author of journalistic surveys on food, she has published the book "Reading labels to know what we eat".
