Less than a third of women report having taken vitamin B9 supplementation before pregnancy according to the 2021 national perinatal survey carried out by Public Health France. However, these deficits are responsible for malformations in newborns.
The consequences of folate deficiency
In the unborn child, neural tube closure anomalies (NFTN), congenital malformations of the brain, spine and/or spinal cord, affect more than one in a thousand pregnancies in France. The consequences on the development of the fetus vary greatly: fetal growth retardation, premature birth, spina bifida (failure to close the spinal column), anencephaly (absence of the brain leading to the death of the newborn).
The main risk factors are family history of AFTN, diabetes, obesity, and maternal folate deficiency. Exposure to certain medications, particularly antiepileptics (valproate, carbamazepine, topiramate) or certain antiretrovirals (dolutegravir), can also be responsible for these malformations.
What is vitamin B9?
It is a water-soluble vitamin, also called folate or folic acid. It is involved in the production of red blood cells and the synthesis of DNA but is also essential for the normal development of the fetal nervous system. Although present in dried vegetables (e.g. chickpeas, red beans) or green leafy vegetables (lettuce, cabbage, spinach, etc.), intakes are generally insufficient and supplementation for the mother is recommended from the time of pregnancy ( at least 4 weeks before becoming pregnant) then during the first three months.
The recommended dietary intake of vitamin B9 in the population is 300 mcg for adults and 600 mcg per day during pregnancy. As it is rarely affected, supplementation is recommended from the start of pregnancy at 0.4 mg per day. If there is a history of AFTN, it is increased to 5 mg/day.
Enrich wheat flours to reduce deficiencies
Thus, ANSES recommends, in an expert report, systematic enrichment of folic acid at 200 µg/100 g of white and wholemeal wheat flours. The agency is thus aligning itself with a 2023 World Health Organization resolution already implemented in more than 80 countries observing a reduction in AFTN risks.
Wheat flour was favored because it is commonly consumed and economically accessible to the greatest number of people. This would also make it possible to increase intake in the general population without health risk.
Folic acid supplementation (Speciafoldine, Fertifol) would remain recommended for women from the moment they plan to become pregnant.
