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March of Dimes Asks, "Why Isn't the Neural Tube Defects Rate Lower?"
WHITE PLAINS, N.Y., JUNE 20, 2001 – "Why isn’t the neural tube defects rate lower?" the March of Dimes asks in response to an article published today in the Journal of the American Medical Association indicating that these birth defects in newborns are down 19 percent following folic acid fortification of the nation’s grain foods.
"This finding shows that the nation is moving in the right direction to prevent these fatal or disabling birth defects," says Dr. Jennifer L. Howse, president of the March of Dimes. "However, definitive research on folic acid supplementation with multivitamins predicted a 50 to 70 percent decrease in neural tube defects (NTDs) if all women of childbearing age in the United States got an adequate amount of this B vitamin. Why isn’t the NTD rate lower? Have we reached the right level of fortification? Will maintenance at this level bring us all the way to a 50 to 70 percent decline in NTD rates, or has the decrease in NTDs reached a plateau? We won’t know the answers to these questions for several years, and we certainly need better state tracking systems to provide comprehensive data. In addition, we must do much more to promote multivitamin use among women capable of having a baby."
Dr. Howse notes that scientists currently must rely on information about NTD rates and prevention from two separate sources: birth certificates and measurements of blood folate levels in women. "But what’s needed are more studies linking these data to create a picture of the relationship between grain fortification, maternal food intake and vitamin supplement use, maternal blood folate levels, and NTD reduction. To accomplish this, Congress must give the National Center on Birth Defects and Developmental Disabilities more funding to conduct such biologically-based birth defects surveillance and to expand physician and consumer education programs," she says.
The March of Dimes supports the U.S. Public Health Service recommendation that all women of childbearing potential consume 400 micrograms of folic acid daily. Dr. Howse says this is easily done by combining the available sources of the vitamin each day: "Start with a balanced diet that includes lots of folic acid-rich foods such as leafy green vegetables, citrus fruits, peanuts, and beans; choose enriched grain products such as fortified breakfast cereals; and take a daily multivitamin supplement containing folic acid," she says.
Neural tube defects are among the most serious and common birth defects in the United States. Each year, an estimated 2,500 babies are born with these defects, and many additional affected pregnancies result in miscarriage or stillbirth. The most common NTD is spina bifida, a leading cause of childhood paralysis. Another NTD is anencephaly, a fatal condition in which a baby is born with a severely underdeveloped brain and skull.
The Food and Drug Administration has required the addition of 140 micrograms of folic acid per 100 grams of grain to cereals, breads, pastas, and other foods labeled "enriched" since January 1, 1998.
"The Impact of Folic Acid Fortification of the U.S. Food Supply on the Occurrence of Neural Tube Defects" by Margaret A. Honein, Ph.D., and colleagues at the National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, was published in JAMA, volume 285, number 23, June 20, 2001.
The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy to save babies.
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