Dr. Joel Ray, along with fellow researchers Gita Singh of McMaster University in Hamilton and Robert Burrows of Monash University in Australia, reviewed nearly 50 studies conducted in about 20 countries between 1992 and 2001. Their findings are published in the May 2004 edition of BJOG: an International Journal of Obstetrics and Gynaecology.
By taking folic acid before pregnancy or during the first few weeks after conception, women can markedly lower the risk of neural tube defects in their offspring; the defects commonly manifest themselves as a debilitating health condition known as spina bifida. The neural tube is fully developed 22 to 28 days after conception, but many women are not aware they are pregnant until after this time. While starting folic acid supplements after this period is too late to realize benefits, Ray believes the answer is to fortify the food supply with folic acid, something that has been done in Canada, the U.S., Chile and Israel.
"There's an incredible debate overseas, in the United Kingdom and Europe," says Ray, a professor in the Department of Medicine and a physician in the Inner City Health Research Unit at St. Michael's Hospital. "There has been a heated discussion about the long-term safety of folic acid and, while no harm is evident, we are just beginning to study the effects of long-term exposure. But as a society, where's the greater good versus the lesser harm? Fortification is probably the best way to reach most women worldwide, given that not enough women take tablet supplements alone."