In the first of our series exploring the little-known contributions of women scientists to global health, we look at Lucy Wills, whose pioneering work on folic acid changed how we understand the importance of nutrition during pregnancy.
Neural tube defects are one of the most common and serious birth defects. They are a major cause of death and lifelong disability, affecting over 300,000 births worldwide each year.
They occur during the first few weeks of pregnancy, as the neural tube, from which the brain and spinal cord form, develops and closes. When the tube does not close completely a defect, such as spina bifida (a defect in the spinal cord or vertebrae), develops.
We now know that a woman’s level of folate (vitamin B9) plays a critical role in the formation of the neural tube. It is one of the main reasons why folic acid (a synthetic form of folate) is recommended by the WHO as a supplement for pregnant women.
The discovery and use of folate has therefore played a huge role in preventing countless debilitating and even deadly birth defects. And we have a pioneering, adventurous female scientist to thank.
From Cambridge to Cape Town
Born in England in 1888, Lucy Wills’ early life was tinged with tragedy. Within two years of completing a degree in botany and geology at Cambridge University in 1911, she lost both her father, to whom she had been very close, and her elder sister, Edith, who passed away at the age of just 27.
It was likely these family tragedies were the trigger to what became a lifelong thirst for travel for Wills. After travelling to Sri Lanka with her mother, Lucy then moved to South Africa with her brother in 1914. When the first World War broke out in July of that year, she volunteered as a nurse in Cape Town, the beginning of a career in medicine.
Returning to London in 1915, Wills attended the London School of Medicine for Women, Britain’s first medical school that trained women as doctors. In 1920, she gained her medical degree and joined the school’s Department of Chemical Pathology, researching the biochemical mechanisms of the body relating to disease. It was here over the next few years that Wills developed a particular interest in haematology – the study and treatment of blood.
The breakthrough in Bombay
In 1928, Wills travelled to India, to help investigate a particularly severe and potentially fatal form of anemia in pregnancy that had become prevalent in female textile workers in Bombay (now Mumbai).
The anemia was most frequent in poorer populations, so Wills sought to study whether dietary factors played a role. She found that diets deficient in protein, fruit and vegetables correlated with a higher likelihood of the women suffering macrocytic anemia (where red blood cells are larger than their normal volume) in pregnancy.
Following the failure of an initial nutritional intervention trial that focused on vitamins A and C, Wills decided to investigate alternative approaches by studying the effects of changes in diet on pregnant albino rats. Those rats that were fed on the same diet as the poor Bombay women became anemic, dying before giving birth.
Wills discovered that the rat anemia could be prevented by adding brewer’s yeast to a diet otherwise lacking B vitamins. However, the rats suffered from a common infection and concerned that this might be clouding the results, she sought to repeat the test on monkeys. By using a yeast extract that was and remains a popular breakfast food spread in the UK, Wills discovered that she could replicate the success she had had with the rats.
In subsequent therapeutic trials, the yeast extract was then found to both prevent and cure the macrocytic anemia in the pregnant Bombay patients. Wills had made the key observation that a specific nutritional factor was required to prevent anemia during pregnancy. It became known as the ‘Wills factor’ and was the first step in the discovery of folic acid.
How the Wills factor became reality
On her return to London, Wills continued to work on preventing anemia in pregnant women through nutrition intervention. During the 1930s, Wills and her colleagues discovered that alongside yeast, the liver contained nutrients that could treat multiple forms of anemia. These findings helped narrow down the vitamins that were so effective in preventing the condition.
Folic acid received its name in 1941 when it was successfully isolated from spinach by Herschel Mitchell. Two years later, the compound was synthesized for the first-time and by 1945 this synthetic folate was used to help treat anemia. The ‘Wills factor’ had become a treatment.
For the remainder of her life, Wills worked towards improving our understanding of nutrition in pregnancy. She continued to travel the world, from Jamaica to Fiji, observing how diet can affect pregnant women.
Since Lucy’s breakthroughs in Bombay, our understanding of the importance of folic acid in pregnancy, alongside other nutrients such as iron and vitamins B12 and B3, has hugely advanced. By the early 1980s, the first prenatal multi-vitamin supplement containing folic acid, Elevit Pronatal, successfully tested with a controlled clinical trial that these nutrients can help prevent the first occurrence of neural tube defects.
Today, we know that a woman’s dietary intake of nutrients is crucial for a baby’s development and through food fortification and supplements we can help minimize the risk of potential birth defects. For that, we have Lucy Wills’ pioneering work to thank.
- Centers for Disease Control and Prevention: https://www.cdc.gov/features/birth-defects-day/index.html
- World Health Organization: http://apps.who.int/iris/bitstream/handle/10665/77770/9789241501996_eng…