Science - USA (2021-10-29)

SCIENCE science.org 29 OCTOBER 2021 • VOL 374 ISSUE 6567 519

Italy (5.4), perhaps because of diet or wide-

spread use of folic acid supplements by

women before becoming pregnant.

Pressure to fortify in Europe may have

been muted because most affected fetuses

are identified by antenatal screening and

terminated, health experts say. Across

19 EU countries that are full members of

a European Commission registry, 80% of

affected pregnancies were terminated in

recent years. (In the United States, an esti-

mated 23% to 42% are terminated.)

Compared with many other countries, “Eu-

rope has very good access to terminations,”

says Vijaya Kancherla, an epidemiologist at

the Center for Spina Bifida Prevention at Em-

ory University. “There are not as many babies

born with these conditions, so they don’t see

them and they think there is no problem.”

Kancherla adds that many Europeans “see

anything added to food as ... not natural, as

being dangerous to the body. Which is not

true for folic acid.”

Some European experts are wary of poten-

tial adverse effects from excessive folic acid

intake in the general population. That’s what

the German Federal Institute for Risk Assess-

ment (BfR) wrote in a 2017 report rejecting

mandatory fortification. BfR recommended

folic acid intake be boosted only in the target

group of women. “The benefits of folic acid

for a relatively small group must be weighed

against the possible disadvantages for a large

part of the population,” the report argued.

Adverse effects have been seen at very

high doses of folic acid, in excess of 5 milli-

grams daily, or 36 times the amount added

to a 100-gram serving of fortified white

bread in the United States. In the 1940s,

some people with vitamin B12 deficiency

given very high doses of folic acid to treat

anemia developed irreversible neuro-

pathies. More recent studies have hinted

at cognitive impairment in the elderly and

growth promotion of existing cancers. But

other studies have found that folic acid pro-

tects against some cancers. “Strong biological

and mechanistic premises connecting [high

folic acid levels] to adverse health outcomes

are lacking,” a 2019 National Institutes of

Health workshop concluded.

“We have had folic acid fortification in

the U.S. for [23] years and we haven’t seen

skyrocketing rates of colon cancer or other

conditions,” adds Philip Lupo, an epidemio-

logist at Baylor College of Medicine.

Irwin Rosenberg, a physician and nutri-

tionist who is a professor emeritus at Tufts

University, says he’s worried about excess

folic acid from supplements in the United

States, where supplements are popular and

largely unregulated. But he’s not concerned

about fortified flour. The potential adverse

effects of fortification are so weak that they

“really should not have been used ... as an ar-

gument against fortification,” he says.

“The evidence against folic acid [fortifi-

cation] is really weak,” agrees Rima Obeid,

a clinical biochemist at Saarland University

Hospital in Homburg, Germany. “The prob-

lem is you don’t have [a] political interest” in

getting it done.

Possible toxicity from folic acid is the last

thing on the mind of Katya Kovacheva, of

the Medical University, Pleven, in Bulgaria,

who runs the country’s only birth defects

registry. “I have drawn attention to the high

prevalence of NTDs in our country ... unfor-

tunately without a response from the author-

ities,” she says.

Michael Turner, a professor of obstetrics

and gynecology at University College Dublin,

says lobbying authorities country by country

is unlikely to yield results. “I would make a

heartfelt cry for all European countries ...

to come together to standardize mandatory

food fortification in Europe. There needs to

be a pan-European solution to this.” j

*U.K. and EU numbers are averages from 2013 to 2018.

Canada

(1998)

–46%

Chile

(2000)

–50%

Costa Rica

(1997)

–35%

South Africa

(2003)

–31%

United States

(1998)

–36%

United

Kingdom*

European

Union*

0

5

10

15

20

Neural tube defects

per 10,000 pregnancies

Before fortication After fortication

T

he pandemic led to a surge in

COVID-19 research, but it severely dis-

rupted other fields—shuttering labs,

restricting travel, and leaving scien-

tists with children struggling to work

without adequate child care. A flurry of

studies indicates the productivity of women

scientists slowed during the pandemic by

more than that of their male colleagues. Now,

a survey of a large swath of the scientific com-

munity reveals those impacts may be felt for

years to come because many investigators—

especially women and scientists with young

children—were unable to start new research

projects in 2020.

“There may be a cliff looming on the hori-

zon,” says Dashun Wang, a computational so-

cial scientist at Northwestern University who

headed the new study, published this week in

Nature Communications.

Wang’s team polled 7000 U.S. and Europe-

based principal investigators in January,

asking how their research activity in 2020

compared with 2019. Respondents who did

not study COVID-19 reported a drop in pa-

pers published (–9%) and manuscripts sub-

mitted (–15%). But the most glaring falloff

came earlier in the research pipeline, as there

was a 36% decrease in the initiation of proj-

ects. Women and parents of children 5 years

of age or younger were especially hard hit.

The findings are crucial to informing poli-

cies designed to support the careers of re-

searchers impacted by pandemic disruptions,

says Catherine Wagner, an evolutionary bio-

logist at the University of Wyoming who has

written about the challenges she and other

scientist mothers have faced. In addition to

offering tenure clock extensions, for example,

institutions could better support child care

and offer seed grants that support new col-

laborations, she says. “It’s really important to

consider how COVID-19 will impact produc-

tivity far into the future.” j

Jyoti Madhusoodanan is a science journalist

in Portland, Oregon.

Pandemic

productivity

dip may linger

Scientists started fewer new

research projects in 2020

COVID-

By Jyoti Madhusoodanan

NEWS

The power of folic acid

The prevalence of neural tube defects dropped notably in the years after these countries began to fortify flour with

folic acid. The European Union does not require fortification and the United Kingdom just decided to do so.

CREDITS: (GRAPHIC K. FRANKLIN/

SCIENCE

; (DATA EUROPEAN COMMISSION; NATIONAL CENTER ON BIRTH DEFECTS

AND DEVELOPMENTAL DISABILITIES/U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION