Folate win for Aboriginal babies

After 30 years of hard work, Telethon Kids Institute researcher Carol Bower is celebrating the final confirmation of all that she ever dared hope for.

Numbers have been crunched and revealed that the mandatory fortification of wheat flour for breadmaking with the vitamin folic acid has done its job extremely well.

Lobbied for vigorously by the Institute and introduced across the country in September 2009, it’s been hugely successful at increasing folate levels and dramatically reducing the rates of serious birth defects in the Aboriginal population.

The fall-off in spina bifida and other neural tube defects (NTD) has been significant, with a 68 per cent reduction in prevalence in the WA Aboriginal population data recorded by the WA Register for Developmental Anomalies. This comes on top of a 15 per cent reduction recorded for the WA population as a whole.

With the gains reported recently in the Australian and New Zealand Journal of Obstetrics and Gynaecology, after the analysis of data on 52,919 Aboriginal births from 1980 to 2014, this is the first scientific paper to show the real and tangible impact of fortification in Australia - a Federal Government decision which Professor Bower and Institute Founding Director and Patron Professor Fiona Stanley fought hard for.

Not only did their research help confirm the link between inadequate levels of folate and neural tube defects, they personally led a number of promotional campaigns encouraging women to increase their folate intake and raising awareness of the effectiveness of bread fortification.

Professor Carol Bower

“It’s great news,” said Professor Bower. “Neural tube defects are devastating birth defects of the brain or spinal cord, which can cause serious disability and even death.

“And the Aboriginal population was at a higher level to start with – with the defects being almost twice as common – so there was more benefit to
be gained there.”

Folate levels have traditionally been much lower in Aboriginal communities, where there is less access to fresh fruit and vegetables which contain the essential vitamin.

Yet adequate folate levels in the diet of women before conception is essential to reducing the risk of disruptions in the baby’s neural tube as it closes within the first few weeks following conception.

Concerns were raised a decade ago when promotion of the use of folic acid supplements (from 1992) and voluntary fortification of several foods (from 1995), failed to bring the same gains to WA’s Aboriginal communities as seen in the general population.

An increasing disparity in the birth prevalence of NTDs between Aboriginal and non-Aboriginal infants then emerged, increasing from a 42 per cent excess in 1980–1992 and reaching an almost twofold difference in 1996–2000.

“And very sadly a lot of these Aboriginal babies were stillborn or died at birth from anencephaly,” said Professor Bower. “So, unless you have got something like the WA register to be tracking these cases, the higher prevalence doesn’t reach consciousness in the population as a problem.”

In addition to the reduction in NTDs, the increase in folate levels brought by fortified bread is expected to lead to gains in the general health of both Aboriginal men and women.

“Aside from pregnancy and preventing neural tube defects, this could be a big plus for the Aboriginal population as whole because being folate deficient can cause anaemia and ill health,” said Professor Bower.

In the Institute study analysing blood samples taken at Derbarl Yerrigan Health Service in Maddington and the WA Country Health Service in the Goldfields, for the 95 Aboriginal men and non-pregnant women aged 16–44, no participant was folate-deficient post-fortification. Yet in earlier pre-fortification samples, 10 per cent of women and 26 per cent of men had deficient red cell folate levels. Also there was no evidence of B12 deficiency.

Most ate fortified shop-bought bread at least weekly and half ate it every day.

“From the two Aboriginal groups that participated and Aboriginal researchers involved in the study, we have had some good feedback,” said Professor Bower.

“We were told that there are ‘all these little bits’ that contribute to closing the gap in life expectancy and that this is one of those.

“It’s important.”