Neural tube defects in neonates are common in Germany compared with the rest of Europe. Extensive folic acid fortification of foods in Germany might prevent these in 85-100% of cases, Wolfgang Herrmann and Rima Obeid argue in this issue of Deutsches Ã„rzteblatt International (Dtsch Arztebl Int 2011; 108; 249-54).
A woman's folic acid intake before and during early pregnancy ensures that the fetus does not develop the neural tube defect commonly known as spina bifida. Every year, 800 pregnancies in Germany are diagnosed with a neural tube defect. Most of those pregnancies are terminated.
However, the mandatory fortification of foods with folic acid is subject of controversy in Germany. Overdosages of folic acid are suspected of accelerating the growth of certain cancers. Herrmann and Obeid evaluate different international studies and show that this suspicion is not supported by the evidence. No association was found, for example, for the observed increase in the number of patients with colorectal cancer after folic acid fortification programs started in the United States and Canada. According to Herrmann and Obeid, the increase can be explained by improved early detection programs during this time period.