Women need to get enough folic acid every day throughout
their reproductive years. To prevent NTDs, a woman must take folic acid daily at least one
month before she conceives and continue taking it through the first trimester (three
months) of pregnancy. All women capable of becoming pregnantnot just those planning
a pregnancyshould consume enough folic acid every day, because half of all the
pregnancies in the United States are unplanned. Remember, NTDs occur before many women
know that they are pregnant.
How Much Folic Acid Is Needed to Prevent NTDs?
In 1992, the U. S. Public Health Service (PHS)
recommended that all women of childbearing age consume 400 micrograms (0.4 milligram) of
folic acid every day to reduce their risk of having an NTD-affected pregnancy.
For women who have already had an NTD-affected
pregnancy, the PHS recommends consulting with a doctor about taking a much larger amount
of folic acid (4000 micrograms [4 milligrams]), starting one month before conception and
continuing throughout the first three months of pregnancy.
In 1998, the Institute of Medicine (IOM)
recommended that to reduce their risk for an NTD-affected pregnancy, women capable of
becoming pregnant should take 400 micrograms of synthetic folic acid daily, from fortified
foods or supplements or a combination of the two, in addition to consuming food folate
from a varied diet.
Are Women Getting Enough Folic Acid?
Two-thirds of women in the United States report consuming
insufficient levels of folic acid, even though there are several ways to get 400
micrograms of folic acid a day.
How Can Women Get Enough Folic Acid?
There are three ways women can get enough folic acid to
prevent spina bifida and anencephaly. They can choose to:
Take a vitamin supplement containing
400 micrograms of folic acid daily.
Eat a fortified breakfast cereal daily
which contains 100% of the recommended daily amount of folic acid (400 micrograms).
Increase consumption of foods
fortified with folic acid (e.g., enriched cereal, bread, rice, pasta, and
other grain products) in addition to consuming food folate from a varied diet (e.g.,
orange juice and green vegetables).
1. Take a vitamin supplement with
400 micrograms of folic acid daily.
a vitamin supplement containing folic acid is an easy way to get enough folic acid. Almost
all over-the-counter multivitamins contain 400 micrograms (0.4 milligram) of folic acid,
the amount recommended to prevent NTDs. The label on a multivitamin container will list a
vitamin supplements contents. Recently, more stores are carrying supplements
containing folic acid alone. The cost of vitamins can vary considerably, but women can buy
vitamins containing folic acid for as little as 50˘ to $1.00 a month.
A woman should understand that taking too many vitamin
supplements is not good for her or her baby. Caution should be taken to prevent the
excessive use of multivitamin supplements. Very large amounts of some vitamins can cause
problems. For example, too much vitamin A may cause other types of birth defects.
According to the 1997 March of Dimes survey, 30% of all
childbearing-age women who are not pregnant take a daily multivitamin supplement
containing folic acid. Among women age 25 and under, only 19% take a vitamin supplement
daily. Yet this population of women accounts for 39% of all U.S. women giving birth.
Challenges faced by health educators and promoters include:
Increasing knowledge of women, especially
younger women, about the benefits of folic acid.
Motivating women to get adequate amounts of
folic acid daily.
Informing women about reliable sources of
synthetic folic acid.
2. Eat a fortified breakfast cereal daily which
contains 100% of the recommended daily amount of folic acid (400 micrograms).
A few cereals have enough added folic acid per serving to
meet 100% of a womans daily need. Fortified breakfast cereals that contain 100% of
the recommended daily amount of folic acid (e.g., Total®, Product 19®, Multi-Grain
Cheerios Plus®, and Smart Start®) are good options for women who do not want to or
cannot take a vitamin supplement.
3. Increase consumption of foods fortified with folic
acid in addition to consuming food folate from a balanced diet.
Effective January 1, 1998, the U. S. Food and Drug
Administration ordered that all enriched cereal or grain products be fortified at a level
of 140 micrograms (0.14 milligram) of folic acid per 100 grams of grain product. While
this level of fortification offers some protection against NTDs, most women will not get
enough folic acid through fortified grain products alone.
In addition to getting 400 micrograms of synthetic folic
acid, women should consume food folate from a variety of foods. Foods rich in folate
include orange juice from concentrate, dark-green leafy vegetables (e.g., spinach,
broccoli, asparagus, and romaine lettuce), beans, grains, citrus and other fruits (e.g.,
kiwis and strawberries), and liver. A list of foods that are good sources of folic acid
and folate is provided in Appendix B. However, women capable of becoming pregnant who eat
a healthy diet still need to take a vitamin supplement, eat a breakfast cereal containing
100% of the daily value of folic acid daily or increase their consumption of foods
fortified with folic acid to achieve the recommended amount of folic acid for the
prevention of NTDs.5