Although folic acid supplementation before conception cannot prevent neural tube defects in every case, regular folic acid intake can lower the risk of this malformation by 75% and in the repeat scenario by 70%. One cause for folic acid administration to fail in preventing neural tube defects may in some cases be the presence of unidentified celiac disease. If such a gluten-related enteropathy is present, where the small intestine’s resorption is impaired owing to more or less pronounced atrophy of the villi of the small-intestinal mucosa, then the resorption of folic acid is reduced too. We have described this problem in detail elsewhere (1). Celiac disease should therefore be ruled out in every woman who gives birth to a baby with a neural tube defect. This is done by measuring celiac specific serological antibodies, such as the endomysial antibodies or tissue transglutaminase antibodies. Since these antibodies belong to immunoglobulin class A, IgA deficiency needs to be ruled out at the same time. If a woman tests positive for antibodies then the presence of celiac disease needs to be confirmed by a a small intestinal biopsy, using gastroduodenoscopy. It would be optimal to test all women for celiac disease before they become pregnant.
Recently, orofacial clefting has also been considered in association with folic acid deficiency (2).
Footnotes
Conflict of interest statement
Professor Henker declares that no conflict of interest exists. Professor Zimmer holds shares in the Rhön-Klinikum (medical center) and also receives licensing fees. He holds a patent for the gliadin-peptide vaccine. Professor Zimmer has also received honoraria for acting as an adviser, from Sanofi and Merck. Falk has reimbursed his travel expenses and participation fees. Nestlé and Falk have both paid honoraria for speaking. He has received moneys in third-party accounts from Nestlé.
References
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