More Women Of Reproductive Age Need Folic Acid To Prevent Birth Defects

Jennifer Williams MSN, MPH, FNP-BC National Center on Birth Defects and Developmental Disabilities CDC, Atlanta, Georgia MedicalResearch.com Interview with:
Jennifer Williams MSN, MPH, FNP-BC

National Center on Birth Defects and Developmental Disabilities
CDC, Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Response: Neural tube defects are serious birth defects of the brain and spine that can cause significant disability and death. Studies have shown that taking 400 mcg of folic acid daily before and during pregnancy can reduce the prevalence of neural tube defects. Therefore, in 1992, the US Public Health Service (USPHS) recommended that all women of childbearing age in the United States who are capable of becoming pregnant consume 400mcg of folic acid per day to reduce the risk of neural tube defects. To help women meet this requirement, in 1998 the US Food and Drug Administration (FDA) mandated that folic acid be added to enriched grain products for the prevention of neural tube defects.

This study looks at how many neural tube defects have been prevented annually since folic acid fortification. Using data from birth defects tracking systems, researchers found that since folic acid fortification, the birth prevalence of neural tube defects has decreased by 35% in the United States, which translates to about 1,300 babies that are born each year without a neural tube defect who might otherwise have been affected.  This study also reports that the number of babies born with a neural tube defect annually differs by the mother’s race/ethnicity. Hispanic mothers continue to be at the highest risk for having a baby with a neural tube defect.

Medical Research: What should clinicians and patients take away from your report?

Response: CDC urges all women of childbearing age, whether planning a pregnancy or not, to get 400 mcg of folic acid daily from fortified foods, vitamin supplements containing folic acid, or both in addition to consuming folate-rich foods from a varied diet. It is especially important for women to get this amount of folic acid at least one month before becoming pregnant to help prevent neural tube defects.

Folic acid fortification is one important way to help prevent neural tube defects. Unfortunately, even with folic acid fortification, not all women of reproductive age are getting the recommended amount of folic acid, which puts them at risk for a pregnancy affected by a neural tube defect.  Additional public health interventions targeting these women could help reduce the number of babies born each year with a neural tube defect even further.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Current fortification efforts should be maintained to prevent neural tube defects. There are still opportunities for prevention among women with lower folic acid intakes, especially among Hispanic women, to further reduce the prevalence of neural tube defects in the United States. Further, prevention efforts should address other known risk factors for neural tube defects, for example obesity, diabetes, use of certain medications, or having had a previous neural tube defect affected pregnancy) to reduce the occurrence of these serious birth defects.  Lastly, research to identify additional preventable risk factors for birth defects is urgently needed.

Citation:

Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011

MMWR Weekly January 16, 2015 / 64(01);1-5