Red Blood Cell Folate Level Is a Biomarker for Risk of Neural Tube Defects

The importance of maintaining high red blood cell (RBC) levels of folate during pregnancy to reduce risk of neural tube defects was confirmed in a review of results obtained by a large study of expectant mothers in China.

A team of American and Chinese researchers worked with results obtained from 247,831 participants in a prospective community intervention project in China (1993–1995) that was designed to prevent neural tube defects with 400 micrograms/day folic acid supplementation. An additional 1194 participants came from a population based randomized trial (2003–2005) designed to evaluate the effect of folic acid supplementation on blood folate concentration among Chinese women of reproductive age.

Results revealed that the risk of neural tube defects was high at the lowest estimated RBC folate concentrations (for example, 25.4 neural tube defects per 10,000 births at 500 nanomoles/L) and decreased as estimated RBC folate concentration increased. Risk of neural tube defects was substantially reduced at estimated RBC folate concentrations above 1,000 nanomoles/L (for example, six neural tube defects per 10,000 births at 1,180 nanomoles/L).

The data derived from the Chinese studies was consistent with the existing literature on the link between folate and neural tube defects. Furthermore, neural tube defect risk estimates developed using the proposed model and population level RBC information were consistent with the prevalence of neural tube defects in the American population before and after food fortification with folic acid. Therefore, the authors concluded that RBC folate concentrations, as a biomarker for risk of neural tube defects, could be used to facilitate evaluation of prevention programs as well as to identify subpopulations at elevated risk for a neural tube defect affected pregnancy due to folate insufficiency.

The study, which was carried out by investigators at the [US] Centers for Disease Control and Prevention (Atlanta, GA, USA) and Peking University, Beijing, China), was published in the July 29, 2014, online edition of the British Medical Journal.

Related Links:
Centers for Disease Control and Prevention
Peking University