Why Folic Acid is not to blame

There is lots of speculation about a connection between folic acid, the MTHFR gene mutation and the increase in infant tongue-tie incidence. This topic comes up frequently in online parenting groups and sometimes in the wider media. The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase. This enzyme is involved in a chemical reaction involving folate. The theory is that a mutation in this gene leads to folate deficiency and people with this mutation cannot process the folic acid recommended preconception and during pregnancy. Folic acid supplementation is recommended to prevent neural tube defects, such as spina bifida. To date there are no published research papers demonstrating a link between folic acid supplementation and tongue-tie. In fact a study by Perez-Aguire et al (2018) which looked at folic acid consumption and a number of oral findings in new-borns found no link with tongue-tie.

The evidence suggests that tongue-tie is genetic in origin as it seems to run in families and there may be environmental triggers, as yet unknown. It is imperative that the Department of Health guidelines  on folic acid supplementation pre conception and in pregnancy are followed by parents and reinforced by healthcare professionals as this has been shown to be very effective in reducing cases of neural tube defects.

3 Comments on “Why Folic Acid is not to blame”

  1. I was a midwifery sister in the 1970s I rarely saw a tongue-tie, I now work as a practice nurse and I have noticed an increase in babies with tongue-tie.
    My three daughters have recently given birth and each of my grandchildren had tongue-ties, one required intervention.
    I am quite concerned about this there is no family history of tonge-ties.
    I feel this needs researching.

    1. I believe there is some research underway to determine the influence of folic acid on the presence of tongue ties. I would challenge that there may be no family history of tongue ties as from experience we find parents or grandparent with an undiagnosed tongue tie. Most believe there anatomy is normal because they have no comparison to make but often there will be a significant history of feeding issues, poor milk supply etc.

  2. Dear Suzanne,
    Thank you so much for your reply.
    In my family we have been successful breast feeders and the current living family do not have any tongue ties.
    I am unsure about my other patients. It may be interesting to audit this.
    I am reassured that this is being looked into.
    It is interesting that folic acid is being considered as we only introduced it in the late 70’s or 80’s at the hospital where I practised as a midwife.
    Thank you so much for replying to my concerns.

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