• Folic Acid: A "Family Values" Vitamin

    IMAGEFolic 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 cannot take place. Folic acid is found in orange juice, leafy green vegetables, and beans. The US Food and Drug Administration (FDA) requires folic acid to be added to enriched grains, such as breads, cereals, and pasta.

    Preventing Birth Defects

    Through its role in the cellular processes required for normal fetal development, folic acid helps prevent neural tube defects (NTDs). Occurring in about one in 1,000 births, NTDs are among the most serious birth defects in the United States. 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.
    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's spine does not close completely, is the most common NTD. 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 is 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.
    The problem, however, is that nearly half of all pregnancies in the United States are unplanned. Because of this, the March of Dimes and United States Public Health Service have recommended that all women of childbearing age, including all teenage girls, consume 400 mcg (micrograms) of folic acid each day. Most multivitamins contain this amount, as do some fortified breakfast cereals. Other good food sources include beef liver, black eyed peas, spinach, asparagus, and baked beans.
    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.

    Getting a 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.

    Becoming More Aware

    Unfortunately, many women are unaware of the recommendations regarding folic acid intake. To help spread the word, one week in January is dedicated as National Folic Acid Awareness Week, a time to spotlight NTD prevention. It's an opportunity to get the word out that some disabling or fatal birth defects are easily preventable.

    Getting the Recommended Amounts

    Daily Intake of Folate

    Recommended daily allowances and adequate intake levels for folate:
    Age Micrograms (mcg) per day
    0-6 months 65 mcg
    7-12 months 80 mcg
    1-3 years 150 mcg
    4-8 years 200 mcg
    9-13 years 300 mcg
    14 years and older 400 mcg
    Pregnant women 600 mcg
    Nursing women 500 mcg

    Upper Limits of Folate

    Here are the tolerable upper intake levels for folic acid from fortified foods or supplements:
    Age Micrograms (mcg) per day
    1-3 years 300 mcg
    4-8 years 400 mcg
    9-13 years 600 mcg
    14-18 years 800 mcg
    Pregnant or nursing women up to 18 years 800 mcg
    19 years or older 1000 mcg
    Pregnant or nursing women 19 years and older 1000 mcg


    Centers for Disease Control http://www.cdc.gov

    March of Dimes http://www.marchofdimes.com


    Health Canada http://www.hc-sc.gc.ca

    Women's Health Matters http://www.womenshealthmatters.ca


    Christian P, Khatry SK, Katz J, et al. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial. BMJ. 2003;326(7389):571.

    Folate. Office of Dietary Supplements, National Institutes of Health website. Available at: http://ods.od.nih.gov/factsheets/Folate-HealthProfessional. Updated December 14, 2012. Accessed June 18, 2013.

    Folic acid keeps you and your baby healthy. March of Dimes website. Available at: http://www.marchofdimes.com/pregnancy/folicacid%5Fbefore.html. Updated February 2010. Accessed June 18, 2013.

    Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LY. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA. 2001;285:2981-2986.

    Neural tube defects (NTDs). Duke Center for Human Genetics website. Available at: http://www.chg.duke.edu/diseases/ntd.html. Accessed June 18, 2013.

    Vitamin supplementation ineffective for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 4, 2013. Accessed June 18, 2013.

    6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Ionescu-Ittu R, Marelli AJ, Mackie AS, Pilote L. Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ. 2009;338:b1673.

    11/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Christian P, Stewart CP, LeClerq SC, et al. Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial. Am J Epidemiol. 2009;170:1127-1136.

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