Teh French National Agency for Food, Environmental and Occupational Health Safety (Anses) has recently recommended enriching wheat flour with folic acid, a synthetic form of vitamin B9, to help prevent serious congenital malformations, especially neural tube defects. This proposal, aimed at improving public health, echoes a similar suggestion made in 2003 that did not gain traction. Experts, including Professor Sébastien Czernichow from Paris-Cité University, are now weighing the potential benefits against possible adverse effects on certain populations, highlighting the ongoing debate about nutritional interventions in food products.
In France,congenital neural tube defects affect more than one in a thousand pregnancies,with various risk factors contributing to these malformations,including family history,certain medications like antiepileptics,diabetes,obesity,and insufficient folate intake in expectant mothers. The French Agency for Food, Environmental and Occupational Health & Safety (ANSES) now recommends a daily intake of 600 micrograms of vitamin B9 (folate) at least four weeks before conception and continuing through the first trimester. This is a significant increase from the previous guideline of 400 micrograms established in 2003. However, a 2021 national perinatal survey revealed that less than one-third of women adhere to these supplementation recommendations, with compliance decreasing among younger mothers and those facing social inequalities. d’un niveau d’éducation bas, moins elles déclarent avoir commencé à prendre de la vitamine B9 avant leur grossesse », rapporte le communiqué.
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afin d’améliorer la prévention de ces anomalies,l’Anses préconise un enrichissement des farines de blé en acide folique,la forme synthétique de la vitamine B9,en plus de la supplémentation des femmes ayant un projet de grossesse. « Cette mesure permettrait de compenser les apports insuffisants en vitamine B9 chez ces femmes,qui constituent l’un des principaux facteurs de risque d’AFTN chez l’enfant à naître »,indique le communiqué. À leur état naturel,les folates se trouvent principalement dans les légumes verts,les agrumes,les œufs et les fromages.
Une supplémentation déjà mise en place aux États-Unis
Le Pr Sébastien czernichow explique : « on sait que pour avoir un effet favorable, il faut agir avant le début de la grossesse et quand cette dernière est programmée, il est facile de commencer la supplémentation. Mais comme la majorité des grossesses sont non programmées,le tube neural s’est déjà fermé (ou non) au moment où les femmes constatent qu’elles sont enceintes.C’est pour cette raison qu’on donne des suppléments en acide folique de manière préventive aux femmes qui ont un désir de grossesse et qui vont arrêter la contraception. »
Or ces mesures préventives sont difficiles à mettre en œuvre sur une population générale : « On ne peut pas dire aux femmes de prendre des comprimés d’acide folique en continu toute leur vie en attendant qu’elles tombent enceintes », signale le médecin. « L’idée est d’enrichir les aliments courants », et c’est pour cela que la suggestion s’est portée sur les farines. Ainsi, « une partie va être absorbée, et cette exposition sur le long terme va augmenter le taux de vitamine B9 dans le sang », ce qui préviendra les anomalies en cas de grossesse.
L’efficacité de cette méthode a déjà été prouvée aux États-Unis, où de l’acide folique est ajouté dans de nombreuses farines depuis 1998. Le nombre d’anomalies du tube neural y a chuté de 35 %, soit 1300 naissances de moins affectées par cette pathologie, selon le center de contrôle des maladies et de prévention.
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Des effets positifs…
Recent studies highlight the multifaceted benefits of folic acid supplementation, particularly in reducing the risk of coronary heart disease, stroke, and cognitive decline, including Alzheimer’s disease. However, experts caution that excessive folate intake may pose risks for certain populations, especially women of childbearing age. Professor Sébastien Czernichow emphasizes the need for targeted health interventions, as widespread folic acid fortification in foods could inadvertently expose the entire population to potential health risks. Notably, an overabundance of folic acid can mask vitamin B12 deficiency symptoms, leading to irreversible neurological damage, as warned in a 2021 study published in the Journal of Nutritional Biochemistry.Recent research highlights potential risks associated with excessive intake of vitamin B9, commonly known as folic acid, particularly among older adults. A study conducted on rodents suggests a possible link between high levels of folic acid consumption and a weakened immune response to viral infections, raising concerns about the implications for human health. Additionally, experts warn that combining folic acid with other supplements may lead to digestive issues, including nausea, diarrhea, and stomach cramps. As awareness grows, health professionals urge individuals to monitor thier vitamin intake to avoid adverse effects.
Time.news Editor: Welcome, Professor Czernichow. It’s a pleasure to have you here for this significant discussion about the recent recommendations from Anses regarding folic acid supplementation.
Professor Sébastien Czernichow: Thank you for having me. It’s a vital topic, especially considering the potential benefits for maternal and child health.
Editor: Absolutely. Anses has proposed enriching wheat flour with synthetic folic acid to help reduce congenital neural tube defects—a significant public health concern. Would you mind explaining why folic acid is so crucial, particularly in the context of pregnancy?
Professor Czernichow: certainly. Folic acid, or vitamin B9, is essential for the proper advancement of a fetus. It plays a crucial role in DNA synthesis and cell division.When women have adequate folate levels before and during early pregnancy, they can significantly lower the risk of neural tube defects, which affect the brain and spinal cord.
Editor: That explains why Anses is advocating for this measure. However, I understand that their guidelines recommend a daily intake of 600 micrograms of vitamin B9—an increase from the previous 400 micrograms. What do you think prompted this shift?
Professor Czernichow: The increase likely reflects new evidence about the prevalence of neural tube defects and the necessity for higher folate levels to achieve optimal pregnancy outcomes. Studies indicate that many women fail to meet the previous guidelines, especially those facing socio-economic and educational challenges. This is concerning given that congenital defects affect more than one in a thousand pregnancies in France.
Editor: That’s a significant statistic. Anses has also pointed out that compliance with supplementation is less than one-third among women, particularly those who are younger or have lower education levels. How can public health initiatives address this gap effectively?
Professor Czernichow: It’s essential to increase awareness and accessibility.Educational campaigns targeting women of childbearing age are crucial, especially in communities with lower socio-economic status. Additionally, integrating folic acid enrichment into common food products like wheat flour could provide a more worldwide safeguard against deficiency, particularly for those who may not be aware of their pregnancy until it is indeed too late.
Editor: It’s intriguing that similar measures have been implemented in the United States with positive outcomes. Do you think France could see similar success if Anses’ recommendations are enacted?
Professor Czernichow: I believe there’s great potential for success. The U.S.has demonstrated that fortifying foods with folic acid can lead to a noticeable decrease in neural tube defects. however, it’s crucial to monitor the potential implications for various populations, as some groups may react differently to increased synthetic folate intake.
Editor: That’s a valid concern, and it showcases the importance of tailored health interventions. With the ongoing debates surrounding nutritional interventions,how can we ensure that the recommendations do not overlook vulnerable populations?
Professor Czernichow: A multifaceted approach is vital. Alongside fortification,we should promote education regarding nutrition for both young women and their families. We also need to monitor supplementation practices and outcomes, ensuring that interventions address specific needs and challenges faced by diverse populations.
Editor: thank you for your insights, Professor Czernichow.It’s essential to prioritize women’s health and the healthy futures of children by understanding and navigating the complexities of nutrition and public health recommendations.
Professor Czernichow: Thank you for bringing attention to this critical issue.I hope for fruitful discussions and effective measures that can improve health outcomes for mothers and babies alike.