Women Must Consume More Folic Acid To Ensure Healthy Pregnancies, Study Finds

11 Jan 2017 --- Despite the mandatory addition of folic acid to enriched grain products in the United States, many women still do not consume adequate amounts of the important vitamin, according to a new editorial published in JAMA Pediatrics during Folic Acid Awareness Week and January's Birth Defects Prevention Month.

The editorial ran in conjunction with a new report from the US Preventive Services Task Force (USPSTF), which was also published in JAMA, the Journal of the American Medical Association.

When taken prior to and during early pregnancy, folic acid is known to reduce the risk of having a child affected with a neural tube defect. Neural tube defects include anencephaly, a condition in which a baby is born without parts of the brain and skull, and spina bifida, which occurs when the spinal cord and the bones surrounding the spine do not form properly.

In the United States, approximately 1,200 pregnancies are affected by anencephaly and 1,500 babies are born with spina bifida each year, according to the Centers for Disease Control and Prevention (CDC).

According to the USPSTF recommendation, which was first issued in 2009,

women who are planning or capable of pregnancy should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mg) of folic acid to reduce their risk of having a pregnancy affected by a neural tube defect.

“Since neural tube defects occur in the first few weeks of pregnancy, it is important for women to be taking the recommended amount of folic acid before they become pregnant,” said the editorials author, Laura E. Mitchell, Ph.D., professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health.

“Because approximately one-half of pregnancies in the United States are unplanned, the USPSTF recommendation holds for all reproductive-age women, whether or not they are planning a pregnancy, so that all pregnancies benefit from this preventive measure.”

Although the USPSTF recommendation on folic acid supplementation has not changed since the task force's prior report in 2009, the current report considered new evidence obtained after mandatory folic acid fortification of the country's food supply.

The United States Food and Drug Administration (FDA) mandated folic acid fortification of grain products, such as enriched flour and bread, in January 1998. However, data from the National Health and Nutrition Examination Survey indicate that even with fortification, nearly a quarter of all reproductive-age women have folate levels that are sub-optimal to prevent neural tube defects.

Further, women who do not take folic acid supplements are approximately three times more likely to have sub-optimal folate levels compared to women who take supplements.

“Even in the era of mandatory folic acid fortification of the food supply, taking a daily supplement remains a critical strategy for women to make sure they are receiving enough folic acid,” Mitchell said.

The Council for Responsible Nutrition (CRN), the leading trade association for the dietary supplement and functional food industry, issued a statement in response to a recommendation statement.

Duffy MacKay, N.D., senior vice president, scientific & regulatory affairs, CRN, said: “Folic acid supplementation is proven to prevent neural tube birth defects in babies, and we commend the U.S. Preventive Services Task Force (USPSTF) for its continued recommendation that all women of child-bearing age supplement with folic acid to avoid experiencing this devastating birth defect.”

“Specifically, the USPSTF recommendation calls for all women who are planning a pregnancy or are capable of becoming pregnant to supplement with 0.4 to 0.8 mg of folic acid. This amount is typically found in multivitamins and pre-natal vitamins and consumers should check labels and talk with their healthcare practitioner to ensure they’re getting the right amount.”

“Even in the era of food fortification, essential nutrients needed for optimal health are not always easily attained through diet alone, something acknowledged in the USPSTF report.”

“Government data have repeatedly validated that there is “considerable room for improvement in the use of folic acid supplements across the population of reproductive-age women,” as stated in the accompanying editorial published in JAMA Pediatrics. Thus, we hope that this recommendation, which is supported by reputable institutions, such as the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Academy of Pediatrics, is taken under serious consideration and adhered to for the health and wellbeing of our nation’s future generations.”

“With this strong recommendation for folic acid supplements, the next logical step is to include multivitamins with folic acid within all government nutrition programs, including Supplemental Nutrition Assistance Programs (SNAP).”

“This will ensure that reproductive-age women looking to the government for nutritional assistance will have access to the protective effects of folic acid during pregnancy. Low-income mothers should have the choice to use their SNAP benefits to purchase a multivitamin with folic acid. Furthermore, a multivitamin provides other nutrients, such as iodine, that are critical for a healthy pregnancy.”