New Research Shows Folic Acid In Grains Has Reduced Birth Defects

The March of Dimes restated its longtime position in response to two articles published today in Pediatrics.

"It's so rare that we get the opportunity to save thousands of babiesfrom being born with a disabling or fatal birth defect with such asimple, low-tech means as folic acid fortification," says Dr. JenniferL. Howse, president of the March of Dimes. "Studies have shown thatadequate daily folic acid intake beginning before pregnancy can reducethe incidence of these tragic birth defects by up to 70 percent, and weshould not settle for anything less than maximum prevention."

Since 1996, the March of Dimes has recommended that the U.S. Food andDrug Administration set the level of folic acid required in enrichedgrain foods at 350 micrograms per 100 grams of grain to prevent as manyneural tube defects (NTDs) as possible, said Dr. Howse.

A team of researchers led by Laura J. Williams, M.P.H., of the NationalCenter on Birth Defects and Developmental Disabilities at the U.S.Centers for Disease Control and Prevention (CDC) reported that folicacid fortification accounted for a 36 percent decline in NTDs in theHispanic population and a 34 percent drop among the white, non-Hispanicpopulation between 1995 and 2002. The prevalence of NTDs in the black,non-Hispanic population did not decrease significantly, the CDCresearchers said.

In an accompanying editorial, Robert L. Brent, M.D., Ph.D., and GodfreyP. Oakley, Jr., M.D., MSPM, call on FDA to at least double the amountof folic acid required in enriched grain foods (currently set at 140micrograms of folic acid per 100 grams of grain). They also urged FDAto require grain suppliers to add vitamin B12 to enriched products tooptimize health effects from fortification. The authors also urged themanufacturers of corn flour to make all their products enriched withfolic acid, in order to prevent more NTDs among Hispanic babies.

Dr. Howse said the March of Dimes also supports the idea of enrichingcorn flour with folic acid to help prevent more NTDs among Hispanicsand other populations for whom corn products are a dietary staple.

Before fortification, about 4,000 pregnancies annually were affected byan NTD, some of which resulted in miscarriage or stillbirth. Currently,about 1,000 fewer babies annually develop one of these devastatingconditions in which the neural tube, the embryonic structure from whichthe brain and spinal cord are created, fails to close properly beforebirth.

To help prevent NTDs, the March of Dimes says, all women capable ofbecoming pregnant should consume a multivitamin with at least 400micrograms of folic acid every day starting before pregnancy, as partof a healthy diet containing foods fortified with folic acid and foodsthat naturally contain folic acid, such as leafy green vegetables, andbeans. Daily consumption is crucial because NTDs occur in the earlyweeks following conception, often before a woman knows she is pregnant.

"Decline in the Prevalence of Spina Bifida and Anencephaly ByRace-Ethnicity, 1995-2002," by Ms. Williams and colleagues from CDC andthe University of Alabama at Birmingham, and "The FDA Must Require theAddition of More Folic Acid in 'Enriched' Flour and other Grains," byDrs. Brent and Oakley, appeared in the September issue of Pediatrics,volume 116, number 3.

The March of Dimes is a national voluntary health agency whose missionis to improve the health of babies by preventing birth defects,premature birth and infant mortality. Founded in 1938, it fundsprograms of research, community services, education, and advocacy tosave babies and in 2003 launched a campaign to address the increasingrate of premature birth. For more information, visit the Web site at marchofdimes.com or its Spanish language Web site at nacersano.org.