High Folate Levels on IVF Increases Twins Rate

Women undergoing IVF fertility treatment have a higher chance of having twins if their folate intake is above the recommended dose according to a new prospective cohort study, published in the latest issue of The Lancet (vol.367, pp. 1513-1519). Given the issue of folic acid fortification this finding is quite topical. The USA is reported to have seen a 12 per cent increase in twin births for fertility treated mothers since the introduction of mandatory folic acid fortification in 1998.

In the UK pregnant women are currently prescribed and recommended to take folate supplements to reduce the risk of neural tube defects. However, studies suggest that a lack of compliance is undermining these recommendations, and calls are growing for the introduction of fortification of flour with folic acid. In 1998 the US introduced fortification measures; a move that has seen the number of birth defects fall by 25 per cent. Similar strategies in Canada have seen the instance of birth defects cut in half.

The importance of increasing the intake of folic acid to reduce the incidence of neural tube defects is not something I have a problem with. However, I do not agree with fortification as currently practiced and planned for two important reasons. The first is that it is far too indiscriminant and uncontrolled, resulting in totally unknown dosage levels. The second is that it currently uses refined flours as a delivery vehicle, making them appear to be a health food when in fact refined flours are highly destructive to health and should be avoided.

The issue of unknown dosage is highlighted by this current research, at least in so far as it relates to women who become pregnant using IVF. Multiple births are themselves a significant health risk factor. In addition, it should be noted that the US fortification program has not been regarded as a total success story, with a commentary published in the journal Pediatrics (Sept. 2005, Vol. 116, pp.753-755) claiming fortification levels need to be increased. This further highlights the unknown and uncontrollable dosage levels achieved when relying on fortification. Increasing the level is not the answer.