Folic Acid: A"Family Values" Vitamin
Taking ]]>folic acid]]> can prevent the most common and serious birth defect, known as the neural tube defect—if women only knew it.
Folic acid could be called the "family values" vitamin. Its health benefits begin in the womb and continue into adulthood, from preventing birth defects to possibly reducing the risk of ]]>heart disease]]> .
Folic Acid Facts
]]>Folic acid]]> , also called folate, is a B vitamin, essential for the division of all body cells and the production of DNA and RNA, the genetic material of life. Without it, nothing can grow—not even a single hair or fingernail—and healing can't take place. Folic acid is found in orange juice, leafy green vegetables, and beans. And, since January 1998, the FDA has required that folic acid be added to enriched grains (breads, cereals, and pasta).
Folic Acid and Birth Defects
Through its role in the cellular processes required for normal fetal development, folic acid helps prevent neural tube defects (NTDs). Occurring in one in 1,000 births, NTDs are among the most serious birth defects in the US. NTDs occur when the neural tube, which forms the brain and spinal cord, fails to close. Folic acid supports the normal fusion of the neural tube. "If we give folic acid, the normal (spinal closure) process goes to completion," says Dr. Donald R. Mattison, former medical director for the March of Dimes Birth Defects Foundation.
NTDs include anencephaly and ]]>spina bifida]]> . Anencephaly occurs when a large portion of a baby's brain is not fully formed. This condition is incompatible with life. Spina bifida, which occurs when a fetus' spine does not close completely, is the most common NTD, affecting 2,000 babies annually. According to the March of Dimes, the risk of NTDs could be reduced by 70% if women consumed an adequate amount of folic acid. Another study suggests that folic acid may prevent 50% of birth defects across the board, including ]]>cleft lip and cleft palate]]> .
These statistics are impressive, but there's a catch: Women must consume sufficient levels of folic acid prior to conception since the neural tube is formed very early in pregnancy. Bolstering folic acid status early—about a month prior to starting to try to conceive—ensures that a woman has an adequate amount in her body at conception, explains Dr. Mattison.
The problem, however, is that nearly half of all pregnancies in the US are unplanned. Because of this, the March of Dimes and US Public Health Service have recommended that all women of childbearing age, including all teenage girls, consume 400 micrograms (mcg) of folic acid each day. Most multivitamins contain this amount, as do some fortified breakfast cereals. Other good food sources include spinach, broccoli, asparagus, beets, orange juice, wheat germ, and enriched grain products—including pasta, rice, and cereal—which are fortified to provide 140 mcg per average serving. Other countries also fortify their food with folic acid. Canada, for example, has seen signs of benefit with its fortification program—a decrease in the number of babies born with heart defects, suggesting that folic acid can offer protection beyond neural tube defects. Taking folate and iron may offer additional benefits, like reducing the number of infants born with low birth weight and reducing infant mortality .
The Pre-pregnancy Exam
Once a woman finds out that she is pregnant and goes for her first prenatal visit, she will probably be advised to take a prenatal multivitamin that contains folic acid. However, it may be too late to prevent NTDs at that point. It is imperative that a woman and her partner have a pre-pregnancy check-up to explore pregnancy risk factors and determine the need for folic acid supplementation. "Sitting down for a preconception visit is the perfect opportunity for a woman and her partner to work through and anticipate the issues that must be dealt with," says Dr. Mattison.
Folic Acid Awareness
Unfortunately, most women are unaware of the recommendations regarding folic acid intake. Only 20% of women surveyed in a Gallup Poll conducted for the March of Dimes knew of the connection between folic acid and a lower risk of birth defects. Plus, only 31% of nonpregnant women between the ages of 18 and 45 were found to take a multivitamin containing folic acid. An even smaller number (10%) knew that it must be taken before pregnancy. Of the women who did know about folic acid, most of them had obtained the information from the mass media, rather than from their doctors.
To help spread the word, January 5-11 is National Folic Acid Awareness Week, a time to spotlight NTD prevention. "Opportunities such as this…to reduce the number of babies born with a disabling or fatal birth defect come along so rarely that we must take full advantage of them," says Jennifer L. Howse, president of the March of Dimes.
Folic Acid for Everyone
Getting enough folic acid is one prenatal activity that both expectant parents can share because it has benefits for women and men throughout their lives. This versatile B vitamin helps to maintain appropriate levels of homocysteine—an amino acid, which, in excessive amounts, is thought to damage blood vessels and increase the risk of cardiovascular disease.
According to Dr. Katherine Tucker at Tufts University, "When there's a deficiency of folic acid, the homocysteine cannot move to the next step in its metabolic cycle. So it accumulates in the blood." In confirmation of this statement, her analysis of 747 subjects in the Framingham Heart Study showed that patients who had the lowest folate intake had the highest homocysteine levels. She also stated that the accumulation of homocysteine in the blood may contribute to the narrowing of the arterial walls by making them more susceptible to plaque buildup.
Fortunately, a study published in the Journal of the American Medical Association confirmed that the US policy of folic acid fortification—although designed with pregnant women in mind—has improved the folic acid status of other adults, as well. Moreover, a subgroup of people from the Framingham Heart Study who ate fortified grains had higher folate levels and lower homocysteine levels than a similar group tested prior to the US folic acid fortification policy.
Studies also suggest that folic acid can help prevent ]]>colon cancer]]> and may help treat ]]>depression]]> and even ]]>Alzheimer's]]> disease. However, folic acid is no magic bullet. It's just another example of the wisdom of eating a variety of foods, especially fruits, vegetables, and grains.
Ontario March of Dimes
Women's Health Matters
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March of Dimes website. Available at: http://www.marchofdimes.com/home.asp .
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11/6/2009 DynaMed's Systematic Literature Surveillance
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Last reviewed April 2009 by ]]>Maria Adams, MS, MPH, RD]]>
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