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Pregnant Women Need More Folic Acid to Protect Their Babies

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pregnant women and their babies need more folic acid Brand X Pictures/Thinkstock

A coalition of organizations has petitioned the U.S. Food and Drug Administration (FDA) to start fortifying corn masa flour with the B vitamin folic acid to help prevent or reduce serious birth defects of babies, particularly those born to Hispanic mothers.

Six organizations, Gruma Corporation, Spina Bifida Association, March of Dimes Foundation, American Academy of Pediatrics, Royal DSM N.V., and the National Council of La Raza, say that overall, Hispanic women have a folic acid deficiency that makes them about 20 percent more likely to have a child with a neural tube defect (NTD) than non-Hispanic white women.

It is not well understood why the vitamin deficiency exists within the Hispanic population.

An estimated 3,000 pregnancies each year in the United States are affected by NTDs, serious birth defects of the spine (spina bifida) and brain (anencephaly). As much as 70 percent of these could be prevented if women get adequate amounts of folic acid before and during pregnancy, according to March of Dimes.

“Folic acid fortification of foods has been a common sense public policy that has helped improve pediatric health and significantly reduce the number of neural tube defects, but there is more progress to be made in this area,” said American Academy of Pediatrics President Robert W. Block, MD, FAAP in a written statement.

“The AAP strongly encourages the FDA to allow the fortification of corn masa flour so that a greater population of pregnant women and their unborn children can benefit from this critical nutrient.”

While folic acid fortification of U.S. cereal grains resulted in a 26 percent reduction in NTDs, many women still do not receive adequate levels of folic acid from their diets, according to the March of Dimes.

A 2007 study published in the American Journal of Clinical Nutrition points out low folic acid levels have been particularly pronounced in the past decade, as many women of childbearing age follow low-carbohydrate weight loss diets, which limits many of the fortified foods.

The U.S. Public Health Service recommends that all women of childbearing age consume at least 400 micrograms daily of folic acid, beginning before pregnancy.

Women are urged to take a daily multivitamin containing folic acid as part of a healthy diet that includes folic acid rich leafy green vegetables, orange juice, beans and lentils and fortified foods, such as breakfast cereals and enriched breads and pastas.

Once you're pregnant, increase your daily folic acid intake to at least 600 micrograms by choosing a prenatal vitamin with the right amount of folic acid you'll need during pregnancy, said March of Dimes.

“Most women should limit the amount of folic acid they take to 1,000 micrograms a day unless otherwise directed by a health provider,” according to the organization's web site.

New research published early online in the May 5, 2012 issue of Pediatrics, could give even more reason to fortify common foods with the B vitamin.

Kimberly J. Johnson, PhD, assistant professor at the Brown School at Washington University in St. Louis, and Amy Linabery, PhD, a postdoctoral fellow at the University of Minnesota found folic acid fortified foods likely reduced the incidence of the most common type of kidney cancer and a type of brain tumors in children.

In the largest study to date, the researchers examined the incidence of childhood cancer pre- and post-mandated folic acid fortification. They discovered a reduction in Wilms' tumor, a type of kidney cancer, and primitive neuroectodermal tumors (PNET), a type of brain cancer, since the FDA first allowed folic acid fortification to cereal grain products in 1996, and mandated fortification in 1998.

Data shows Wilms' tumor rates increased from 1986 to 1997 but decreased thereafter coinciding exactly with the mandated folic acid fortification of foods.

"PNET rates increased from 1986 to 1993 and decreased thereafter. This change in the trend does not coincide exactly with folic acid fortification, but does coincide nicely with the 1992 recommendation for women of childbearing age to consume 400 micrograms of folic acid daily," according to the study’s authors.

Kimberly Johnson notes one concern countries face as they are deciding whether or not to fortify foods to reduce NTDs in newborns. This has to do with the possibility that fortification may cause unintended harm, such as causing new cancers or pre-cancerous lesions. She says more research is needed to answer that question.

Lynette Summerill is an award-winning writer and Scuba enthusiast living in San Diego, CA with her husband and two beach loving dogs. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.

Sources and more information:

March of Dimes. Folic Acid: Take Folic Acid Before You're Pregnant. Accessed May 21, 2012. Available at: http://www.marchofdimes.com/pregnancy/folicacid_before.html

Institute of Medicine. Dietary reference intake: folate, other B vitamins, and choline. Washington, DC: National Academy Press, 1998. PDF version at :

What you should know about Folic Acid. Centers of Disease Control and Prevention. Accessed at: http://www.cdc.gov/ncbddd/folicacid/index.html and; U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Spina bifida and anencephaly before and after folic acid mandate---United States, 1995--1996 and 1999--2000. MMWR 2004;53: 362--5.

Quinlivan EP and Gregory JF. Reassessing folic acid consumption patterns in the United States (1999-2004): potential effect on neural tube defects and overexposure to folate. Am J Clin Nutr 2007;86: 1773-9. Access at: http://www.ncbi.nlm.nih.gov/pubmed/18065598

Coalition petitions FDA to fortify corn masa flour with folic acid. March of Dimes Media Release. April 23, 2012. Accessed at: http://phys.org/wire-news/96637353/coalition-petitions-fda-to-fortify-corn-masa-flour-with-folic-ac.html

Childhood Cancer Incidence Trends in Association With US Folic Acid
Fortification (1986 −2008). Amy M. Linabery, Kimberly J. Johnson and Julie A. Ross. Pediatrics; originally published online May 21, 2012; DOI: 10.1542/peds.2011-3418

Reviewed May 22, 2012
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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