PREVENTING SPINA BIFIDA, SHOULD RICE AND FLOUR SUPPLEMENTS NOW

BE MANDATORY?
There is nothing more heart-breaking when one learns the truth of the abnormalities
in her baby during pregnancy. When a doctor informs you that there will be a reddish
sac-like mass protruding from your baby’s back when he is born, that is spina bifida.
Spina Bifida
Spina bifida is a birth defect developed during the first 28 days of gestation in which
the baby’s spine does not close properly and seems to split. In a more severe stage,
the spinal cord is visible and some of the nerves are damaged. Transmission of the
messages to the brain is stopped and the children experience difficulties in walking,
poor bladder and bowel control as well as cognitive problems. Most of them sit on
the wheelchairs and many corrective surgeries are inevitable so as to improve their
mobility and tighten their bladder muscles. Being the primary physical and mental
support, their families are emotionally affected seeing their loved ones suffer
throughout their lives.
Limitations in Prevention
Preventing spina bifida is never easy because the underlying reason of this deformity
has not yet been identified. The experts and the health care professionals are trying
their best to reduce the chances of occurrence through prescribing folic acid
supplements before the women are pregnant, antenatal screening and prenatal
surgery. However, many pregnant women discover their pregnancies only after one
or two months which results in the late consumption of folic acid.
There are also incidents where the spontaneous abortion and miscarriages happen
after the prenatal screening tests are done. In Malaysia, tests are only carried out in
the pregnant mothers aged 35 and above and the ones with the previous history of
having a child or family members with the neural tube defects. Unfortunately, those
who do not fall into these two groups are left out from the screening tests.
Furthermore, prenatal surgery to repair the spines which is done in utero (in the
uterus) also poses risks to the mothers and the foetus such as infection and
premature delivery. Some of the muslim pregnant mothers refuse to have this
surgery as they find that the procedure is against their religious and moral beliefs.

Folate Fortification of Rice and Flour – Mandatory or not?

Seeing the preventive measures are not effective enough to substantially reduce the
rate of spina bifida, the folate fortification of rice and flour is suggested to be
mandatory in Malaysia. A proposal of mandatory fortification of grains was done in
2008 but the result was not heard after all. Rice and flour are the primary staple food
among Malaysians. Consuming fortified grains ensures the adequate daily uptake of
folic acid in the whole population including the women even before they are pregnant
as well as the pregnant mothers coming from the low socio-economic background.

Viewing from the aspect of costs, this fortification strategy is proved to be

inexpensive compared to other interventions in producing folic acid supplements and
organizing campaigns to increase social awareness. However, to achieve a
mandatory fortification, careful and detailed plans are ultimately important in the
processes in monitoring, regulation, production and management of the fortification
by the experts from different sectors.

Folic acid is not only an effective vitamin in helping the early development of foetus
but also treating anaemia. However, there are some studies claiming that the
excessive intake of folic acid will result in irreversible neurological damages to
people who have the vitamin B12 deficiency. The most startling findings even show
that excessive folic acid can will develop breast cancer in women and also interfere
with cancer treatment. However, there are no real life cases which can prove the
accuracy of the research.

There are several countries which have made the food fortification mandatory for
many years such as United States, Philippines and Indonesia. The rates of spina
bifida in these countries have decreased significantly over the years. This shows that
the fortification strategy is a promising and effective measure to prevent spina bifida
which should be implemented in Malaysia. Although there are studies defying the
benefits of folic acid, there are no documented diseases seen in the past decades.
This implies that fortification is safe as long as the level of folate in fortified food is
within the recommended limits proposed by the experts. Mandatory fortification of
staple food should be feasible in Malaysia since there are numerous local mills
practising voluntary fortification of multivitamins in the wheat product. The quality
assurance and evaluation should be carried out from time to time to ensure that the
fortified food is to enhance the health quality of the public. Furthermore, an official
acknowledgement from the government is ultimately essential in reassuring the
public that the mandatory fortification is for the benefits of the people all over the
country.