Birth Defects and Folic Acid

What’s the Problem?

Many defects of the spine and brain can be prevented if women of childbearing age consume folic acid, a B vitamin, every day. Spina bifida is caused by the failure of the spinal column to close normally. People with spina bifida usually have serious disabilities. Their legs and feet are often paralyzed, and they frequently have problems with bowel and bladder control. They also commonly have learning disabilities and, in rare cases, mental retardation. Anencephaly is marked by the incomplete development of the skull bones and a partially or completely absent brain. Babies with anencephaly are stillborn or die shortly after birth.

Folic acid is essential for proper development of the neural tube, which becomes the spinal cord and the brain. Because the neural tube is completely developed by the third to fourth week of pregnancy, before most women realize they are pregnant, women need to be taking folic acid every day before they become pregnant. Taking folic acid every day is also important because half of all pregnancies are unplanned.

Who’s at Risk?

Each year in the United States, about 4,000 pregnancies are affected by spina bifida or anencephaly. Some pregnancies are miscarried or electively terminated; some babies are stillborn. About 1,500 babies are born with spina bifida, and most face severe lifelong disability. The risk for anencephaly or spina bifida among Hispanics is higher than that for the general U.S. population. Use of folic acid supplements tends to be lower among ethnic minorities and low-income women.

Can It Be Prevented?

Fifty to seventy percent of spina bifida and anencephaly cases could be prevented if all women of reproductive age consumed at least 400 micrograms of folic acid (the amount in most multivitamin pills) every day before and during early pregnancy. However, only about 30% of U.S. women and only 19% of those under 25 years old take a daily multivitamin pill. Only about 13% of U.S. women know that folic acid can prevent neural tube defects, and only 7% know that they must take it before they become pregnant. Although folic acid is now added to enriched grain products (bread, pasta, rice, etc), this is probably not enough to prevent all the “folic acid preventable” birth defects.

Some women may not take folic acid because:

• they do not seek medical care until after a positive pregnancy test;
• their health-care providers do not provide them with consistent, or early enough information about folic acid;
• they find pills hard to swallow or think that vitamin supplements are an unnatural way to receive vitamins;
• they find that the iron in multivitamins upsets their stomachs; or
• they forget to take folic acid on a regular basis.

The Bottom Line

In addition to eating a healthy diet, women of childbearing age should take 400 micrograms of folic acid every day (before they become pregnant) to prevent spina bifida and anencephaly. Public health officials recommend that all women of childbearing age consume 400 micrograms of folic acid every day because more than half of all U.S. pregnancies are unplanned. Taking a multivitamin is a convenient way to meet this requirement.

Case Example

A couple is planning on having a baby soon. They want to make sure that they do everything they can so that their baby will be born healthy. The woman schedules an appointment with her doctor to talk about what she should be doing to prepare for a pregnancy. Her doctor tells her that she should make sure that she is eating a healthy, nutritious diet, does not smoke or drink alcohol, exercises regularly, and is taking a vitamin that contains 400 micrograms of folic acid daily before she becomes pregnant and throughout her pregnancy. She tells her doctor that she did not know that she should be taking a vitamin and asks why that is important. The doctor tells her that folic acid is important for the healthy development of an unborn baby and can help reduce the risk of a baby being born with a birth defect of the brain or spine. The woman tells her doctor that she will begin to take her vitamin every day, and she is excited to know that something so small, and easy to do, can make such a big difference! She begins to take folic acid every day in order to have a healthy baby nine months later.