Researchers said Friday that folic acid supplements during the first months of pregnancy can reduce the risk that a women`s child will suffer cleft lip, a disfiguring birth defect.

In another study that also appears in the current online edition of the British Medical Journal, doctors said they could find no effect on a child`s birth weight if the infant`s mother reduces her intake of caffeine.

Folic acid supplementation has previously been shown to prevent serious neural tube defects that can cripple a child. The new evidence suggests that supplementation with the B-vitamin may also reduce risk of facial clefts, said Allen Wilcox, senior investigator at the National Institute of Environmental Health Sciences in Durham, N.C.

'If folic acid is able to prevent a major birth defect in addition to neural tube defects, this benefit should be included among the risks and benefits of fortifying foods with folic acid, a matter of ongoing controversy in many countries,' Wilcox reported.
 

While an exact cause and effect of folic acid supplementation cannot be proven on the basis of his observational studies, Wilcox, using a database of the Norwegian healthcare system, observed that newborns had a 40-percent decreased risk of having a cleft lip if their mothers reported an average daily intake of 400 micrograms of folic acid.

If the mothers reported a high level of intake of foods rich in folic acid -- such as fruits and vegetables -- but did not use folic acid supplements, their children had a 25-percent reduced risk of cleft lip at birth.

In scrutinizing the birth records of children born between 1996 and 2000, Wilcox and colleagues identified 377 children born with cleft lip and 196 with cleft palate only. They were compared with 763 normal children. Their mothers were interviewed regarding their intake of folic acid in the months during early pregnancy -- the period crucial to a child`s structural development.

A woman who eats a lot of vegetables and fruit in the U.S. will probably ingest about 200 to 300 micrograms of folic acid, Wilcox told United Press International. 'The recommendation is that women take a daily supplement of 400 micrograms of folic acid to protect against neural tube defects. There is no problem in taking more than 400 microgram in the form of diet and supplementation,' he said.

He said the study he reported shouldn`t change recommendations, but added it gives another reason why the supplementation is important. 'Women who are planning to get pregnant should begin supplementation with folic acid now,' Wilcox told UPI. 'The critical time for development when folic acid can make a difference is in the early months of pregnancy. If a woman waits until she`s sure she is pregnant before starting supplementation, the ability to impact the outcome with folic acid may have passed.'

'I agree that women who are trying to become pregnant or are thinking about it should begin supplementation with folic acid,' Jennifer Wu, a obstetrician-gynecologist at Lenox Hill Hospital, New York, told UPI.

'By about the ninth or 10th week of pregnancy, the impact of folic acid will have passed and most women do not realize they are pregnant until four or five weeks into pregnancy,' Wu said. 'This study doesn`t really change the recommendation but it does provide a bonus for supplementation by lowering the risk of another birth defect.'

In the second study, Bodil Hammer Bech, assistant professor at the Institute of Public Health at the University of Aarhus, Denmark, attempted to determine if, by reducing coffee intake among women who drank more than three cups of coffee a day, there would be a positive impact on birth weight. Low birth weights are associated with more infant illness.

He was unable to find differences between the two groups of women.

Wu said that the jury is still out on whether high levels of coffee intake impacts outcomes at birth, but that she would rather err on the side of caution.

'Pregnant women should limit the amount of stimulants they ingest, and drinking a lot of coffee during pregnancy should not be encouraged,' she told UPI.