Folic Acid Supplements Needed to Provide Maximum Benefit

WASHINGTON, DC, June 21, 2001—A new study published this week in the Journal of the American Medical Association (JAMA) reports that the number of babies born with neural tube birth defects (NTDs) such as spina bifida has declined 19% since FDA required grain products to be enriched with folic acid in January 1998. That’s good news, but more can be done.

In an editorial accompanying the JAMA article, researchers from NIH rejoice in the fact that food fortification seems to be helping, but emphasize that "women of childbearing age should be advised to take a vitamin supplement containing 400 mcg per day of folic acid to obtain the maximum protection against the development of NTDs."

The March of Dimes urges women to be sure they get enough folic acid every day, and they say, "The best way to get it is to take a multivitamin every day and eat a healthy diet." The Centers for Disease Control and Prevention (CDC) estimate that, if every woman actually got the full recommended amount of 400 micrograms of folic acid daily, the number of babies who suffer from neural tube birth defects such as spina bifida could be reduced by half, or possibly even more than half.

Folic acid is a B vitamin that is naturally found in foods, that is added to some foods, and that is included in multivitamins. It is the closest thing we have to a "silver bullet," when it comes to protecting babies against neural tube birth defects such as spina bifida. But for it to be effective, the mother must be getting enough folic acid before she gets pregnant to permit the baby’s brain and spinal cord to develop normally during the first 28 days of

her pregnancy. Since many women get pregnant without planning to, that means women of childbearing age need to be getting the optimum amount of folic acid every day, all year, every year.

Foods naturally contain some folic acid, but most women only get about half the recommended amount in their diets. In an effort to boost the amount of folic acid in ordinary foods, the Food and Drug Administration has required all enriched grain products to be fortified with some folic acid, since January 1998. This includes enriched grain products like flour, pasta, bread, and rice. The amount of fortification was enough to increase the average woman’s folic acid intake by about 100 mcg (about one quarter of the recommended amount).

During the same period that folic acid fortification was getting started, the March of Dimes and many other national organizations launched a major campaign to educate women about the importance of folic acid and to encourage the use of supplements. That campaign has raised women’s awareness of folic acid and may have contributed to the decline in the number of babies afflicted with NTDs.

When women take multivitamins, they often give them to the whole family. That’s good, because multivitamins with folic acid are likely to help protect against heart disease. Saving babies from neural tube birth defects and protecting parents against heart disease is a combination of benefits that’s hard to beat.

"Silver bullet or not, a multivitamin supplement with folic acid provides a lot of benefits, for pennies a day," said Annette Dickinson, Ph.D., Vice President for Scientific and Regulatory Affairs for the Council for Responsible Nutrition (CRN).

CRN is a trade association representing the dietary supplement industry, and is a member of the National Folic Acid Campaign, headed by the March of Dimes and involving more than 50 organizations committed to reducing the incidence of NTDs.