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Devastating Birth Defects Decreasing With Food Fortification

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They add, however, that the study findings may be a little off because birth certificate data do not always list birth defects, and certificates don't account for fetal deaths or still births, both of which commonly occur in neural tube defect-affected pregnancies. In addition, many neural tube defects are identified by prenatal screening and subsequently terminated.

Also, the 19% drop is far lower than the 50% reduction that some scientists estimated when the program began, prompting some to wonder if food should be enriched with more folic acid.

"It's a little too soon to be sure [whether more fortification is needed], but probably the answer is yes," says Richard Leavitt, director of science information at the March of Dimes, based in White Plains, N.Y.

An increase in folic acid fortification, however, could trigger an unhealthy consequence: pernicious anemia. This form of anemia, or iron-poor blood, damages the brain and nerves and is caused by a deficiency in vitamin B-12. Increased folic acid levels can interfere with detecting this deficiency.

On the flip side, however, folic acid decreases blood levels of homocysteine. High levels of homocysteine are a risk factor for heart disease. It's conceivable that increased folic acid may lower risk of heart disease, but the evidence is not yet in.

In the meantime, Leavitt says, "if you're sexually active and there's any possibility of pregnancy, you need to be supplementing folic acid because just about half of all pregnancies in this country are unplanned. ... women can't safely wait until they make a definite decision to conceive to start."

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