Folic acid is a B-vitamin necessary for proper cell growth and development of the embryo to ward off major birth defects of the brain and spine, known as neural tube defects (NTD) and is required for the production of DNA, which is necessary for the rapid cell growth needed to make fetal tissues and organs early in pregnancy.

“Research has shown that, if taken before and during early pregnancy, folic acid can prevent 70 percent of these birth defects,” Dr. Whitaker said.  “Every woman of childbearing age, even if she is not planning on becoming pregnant, should supplement her diet with folic acid each day.”

An NTD occurs when the neural tube fails to close properly, leaving the developing brain or spinal cord exposed to the amniotic fluid.  The two most common neural tube defects are anencephaly (no brain) and spina bifida (open spine).  All babies with anencephaly die; and children with spina bifida may have damage to the nerves and spinal cord.  For those with spina bifida, the average lifetime cost for medical treatment, educational services and lost productivity is $367,000.  The two conditions occur in the first four weeks of pregnancy, before most women know that they are pregnant. 

Dr. Whitaker noted that the number of babies born with these birth defects has declined since the 1998 requirement that certain foods be fortified with folic acid. 

Adverse pregnancy outcomes are recorded by IDPH for infants with neural tube defects and other birth defects and serious neonatal conditions.  Illinois data show a statistically significant decrease in the occurrence of spina bifida from 1989-2002. In 1989, 67 infants were reported with spina bifida; in 2002 that number was 39. 

The number of cases of anencephaly also declined during this same time period, going from 36 cases in 1989 to 27 cases in 2002.  However, the slight drop in cases is not enough to determine if this decline is a true trend.

“Since 1999, DHS has partnered with the March of Dimes to create the Illinois Folic Acid Coalition,” Dr. Adams said.  “DHS funding has enabled the March of Dimes to conduct an awareness and outreach campaign to educate all women of childbearing age on the importance of taking folic acid every day to reduce the risk of having a pregnancy affected by neural tube defects.  More than 268,000 women in Illinois are reached by this campaign annually.”

Through this campaign, the March of Dimes hopes to reduce the incidence of these birth defects by at least 30 percent, said Gail Wilson, executive director of the Illinois Chapter of the March of Dimes.

“We urge healthcare professionals and pharmacists to use every opportunity to advise women capable of becoming pregnant to consume the recommended amount of folic acid every day as part of a healthy diet,” Wilson said.  “It is crucial that this message reaches women before they become pregnant because serious birth defects of the brain and spine occur in early weeks following conception, often before a woman knows she is pregnant.”  For more information about folic acid and the Illinois Folic Acid Council, contact Veronica Arboleda at the March of Dimes at (312) 596-4717.

This crucial message to women has been delivered in numerous ways including public service announcements; distribution of information at healthcare clinics, hospitals, community-based organizations, health fairs, conferences and other events; and distribution of multivitamins containing folic acid to women of childbearing age through WIC and Family Planning programs at seven local health agencies. 

The daily recommended amount of folic acid is 400 micrograms.  It is recommended that all women of childbearing age take a multivitamin with folic acid.  However, women who have a family history of neural tube defects should take 10 times that amount or 4 milligrams.  It is important, however, that this increased dosage be taken specifically from folic acid supplements, not by increasing the number of multivitamins a woman takes, because of the risk of vitamin A poisoning. 

Another way women can get 400 micrograms of folic acid is by eating a bowl of breakfast cereal containing this recommended daily amount. Women can also eat a healthy diet that contains lots of fruits and vegetables and food fortified with folic acid.  Foods containing folate include fruits and orange juice from concentrate; green, leafy vegetables; and dried beans and legumes.

Studies show that folic acid also can prevent cardiac and cardiovascular disease, Alzheimer’s disease and breast cancer.

Ninety-five percent of NTDs occur in women with no personal or family history of these birth defects.  However, some risk factors are known:

# An NTD-affected pregnancy increases a woman’s chance to have another NTD-affected pregnancy approximately 20 times.
# Insulin-dependent diabetes
# Use of certain anti-seizure medication (Valproic acid/Depakene, and Carbamazapine/Tegretol.)
# Medically diagnosed obesity
# High temperatures in early pregnancy (i.e. prolonged fevers and hot tub use)
# Race/ethnicity (NTDs are more common among white women than black women and more common among Hispanic women than non-Hispanic women)
# Lower socio-economic status