Folic Acid Can Help Prevent
Neural Tube Birth Defects

What are neural tube defects?
In the United States, about 2,500 babies are born with neural tube defects each year. Neural tube defects (NTDs) are birth defects which occur because the neural tube in the embryo does not close properly to form the spinal cord and brain. Improper closing of the neural tube at the upper end results in anencephaly (no brain) and death within days; improper closing of the tube near the lower ends results in spina bifida (open spine) and potentially lifelong disabilities, such as paralysis of the lower body and loss of bowel and bladder function.

What are my chances of having a baby with a neural tube defect?

Approximately one out of every 1,000 babies born in the United States has an NTD. Women who already have a baby affected with a NTD have a risk for recurrence in future pregnancies that is 10 times that of the normal population.

What does folic acid have to do with neural tube defects?

Consumption of folic acid, a B vitamin, before conception and during early pregnancy can prevent the occurence of some neural tube defects. In 1992, the Centers for Disease Control (CDC) recommended that:

"All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs."

If all women of childbearing age took 0.4 mg of folic acid daily at least 1 month before conception through the first 3 months of pregnancy , the number of NTDs would decrease by 50 - 60%. Women who have previously had a child with a NTD should take 4.0 mg of folic acid daily. These women would have a 75% reduction in their risk of having another baby with a NTD.

What causes NTDs?

The cause of all NTDs is still unknown but is thought to be partly due to nutritional deficiency, genetics, or drugs. Certain medications (like some given for seizure control) can also cause NTDs.

Where can I find folic acid?

Folic acid is a B vitamin found mostly in green leafy vegetables, beans (lentil, pinto, chickpea, kidney) and citrus juices. Certain cereals and grains are also fortified with folic acid. Look for "enriched" breads, pastas, and rice as a good source of folic acid.  For example, a bowl of Total or Product 19 provides 0.4 mg of folic acid. All multivitamins also contain at least 0.4 mg of folic acid. A vitamin with 0.4 mg (400 mcg) of folic acid is the easiest and most efficient way to get your daily folic acid needs.

Can folic acid be dangerous to my health?
In general, folic acid is extremely safe at the usual recommended doses.  However, in rare instances, it can sometimes mask a vitamin B-12 deficiency (pernicious anemia) which, if left untreated, could cause some neurologic damage. Most cases of pernicious anemia occur in older people (over 65) who don't eat enough foods that contain B-12 such as meat, fish, poultry, eggs and dairy products. Older people sometimes produce too little stomach acid to free the B-12 from their foods.  

Why does folic acid need to be taken BEFORE conception?

The neural tube develops into the spinal cord and brain between days 18 to 26 after conception. This correlates to the time of the 1st missed period up to 2 weeks after the 1st missed period. Most women are not even aware they are pregnant yet. Because neural tube defects occur so early in pregnancy, folic acid should be started at least one month before conception and continued through the first three months of pregnancy.

Why does folic acid need to be taken by ALL women of childbearing age - not just those wanting to become pregnant?

In the United States, about half of all pregnancies are unplanned.  If only women who were planning to become pregnant took folic acid, we would be missing half the population who would benefit from it. Also, the time to take folic acid is at least one month before pregnancy.

Are there any other benefits to folic acid?

Low folate levels are associated with high homocysteine levels. New research shows that high homocysteine , an amino acid used to make protein, can damage arteries making people more prone to heart attacks, strokes and clogged arteries. Getting enough folic acid can lower homocysteine levels and the risk for heart disease. Folic acid also helps prevent colon cancer and possibly even Alzheimer's disease.