New research shows folic acid in grains has reduced birth defects

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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 babies from being born with a disabling or fatal birth defect with such a simple, low-tech means as folic acid fortification," says Dr. Jennifer L. Howse, president of the March of Dimes. "Studies have shown that adequate daily folic acid intake beginning before pregnancy can reduce the incidence of these tragic birth defects by up to 70 percent, and we should not settle for anything less than maximum prevention."

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

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

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

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

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

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

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

March of Dimes Birth Defects Foundation