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Frequently Asked Questions (FAQs)
The purpose of these questions and answers is to
educate women of childbearing age on the importance of consuming 400
micrograms of folic acid everyday. Folic Acid can help reduce the risk of
spina bifida by up to 70%.
Q: What is folic acid and where can I get it?
Folic
acid is a B-vitamin. The recommended amount to prevent spina bifida and
other neural tube defects is 400 micrograms (0.4 milligrams) of synthetic
folic acid daily. Convenient ways to make sure that you get enough folic
acid:
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Take
a vitamin with 400 mcg of folic acid every day. (Folic acid
pills are small and easy to swallow). Both folic acid pills and
multivitamins can be bought at grocery stores, pharmacies, or discount
stores.
Or
And
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Eat
a healthy diet that contains lots of fruits and vegetables and foods
fortified with folic acid. "Enriched" cereal grain products
such as pasta, rice, bread, flour, and cereals have been fortified
with certain amounts of folic acid. Foods containing folate
include fruits and orange juice from concentrate; green, leafy vegetables; and dried beans and legumes.
Folic
acid in a vitamin supplement, when taken one month before conception and
throughout the first trimester, has been proven to reduce the risk for an NTD-affected pregnancy by 50 to 70 percent. Folic acid is necessary for
proper cell growth and development of the
embryo. Although it is not known exactly how folic acid works to prevent
NTDs, its role in tissue formation is essential. Folic acid 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. That is why it
is important for a woman to have enough folic acid in her body both before
and during pregnancy.
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Q:
What are neural tube defects (NTDs)?
Between
the 17th and 30th day after conception (or 4 to 6
weeks after the first day of a woman’s last menstrual period), the
neural tube forms in the embryo (developing baby) and then closes.
The neural tube later becomes the baby’s spinal cord, spine,
brain, and skull.
A neural tube defect (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 and spina
bifida.
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Q:
What are spina bifida and anencephaly?
Spina
bifida and anencephaly are birth defects that occur in the first four
weeks of pregnancy, before most women know that they are pregnant. Because
about half of all pregnancies are unplanned, it is important to include
400 micrograms of folic acid in every childbearing age woman’s diet.
Spina
bifida occurs when the lower end of the neural tube fails to close.
Thus, the spinal cord and back bones do not develop properly. Sometimes, a
sac of fluid protrudes through an opening in the back, and a portion of
the spinal cord is often contained in this sac. Paralysis of the
infant’s legs, loss of bowel and bladder control, water on the brain
(hydrocephalus), and learning disabilities are among the disabilities
associated with spina bifida. Eighty to ninety percent of infants born
with spina bifida live. Despite varying degrees of disability, many lead
successful and productive lives.
Anencephaly is
a fatal condition in which the upper end of the neural tube fails to
close. In these cases, the brain either never completely develops or is
totally absent. Pregnancies affected by anencephaly often result in
miscarriages. Infants who are born alive die very soon after
birth.
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Q:
Who can have a baby with a neural tube defect in the United States?
Sixty
million women are of childbearing age in the United States; all those who
are capable of becoming pregnant are at risk for having an NTD-affected
pregnancy. It is not possible to predict which women will have a pregnancy
affected by an NTD. Ninety-five percent of NTDs occur in women with no
personal or family history of NTDs. However, some risk factors are known:
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An
NTD-affected pregnancy increases a woman's chance to have another NTD-affected
pregnancy approximately twenty times.
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Maternal
insulin-dependent diabetes
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Use
of certain anti-seizure medication (Valproic acid/Depakene, and
Carbamazapine/Tegretol.)
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Medically
diagnosed obesity
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High
temperatures in early pregnancy (i.e., prolonged fevers and
hot tub use)
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Race/ethnicity
(NTDs are more common among white women than black women and more
common among Hispanic women than non-Hispanic women)
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Lower
socio-economic status
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Q:
Can women get too much folic acid?
Folic
acid has no known toxic level. If you were to eat a bowl of fully
fortified cereal (400 micrograms), take a folic acid supplement (400 mcg), and eat fortified foods and foods rich in folate,
women of reproductive age would not have a problem with too much folic
acid. Even in very high amounts folic acid is non-toxic. Nevertheless, it
is recommended that women consume no more than 1,000 micrograms of
synthetic folic acid a day. Large amounts of folic acid may hide the
ability to quickly diagnose a rare vitamin B-12 deficiency, pernicious
anemia. This condition primarily affects the elderly population and, in
some cases, can lead to neurological damage. Today, doctors can use a
simple test to check for a B-12 deficiency.
Findings
from a survey conducted during July-August 1998 to assess folic acid
knowledge and practices among women of childbearing age in the United
States indicate that of all women surveyed, only 13% knew that folic acid
helps prevent birth defects, and only 7% knew that folic acid should be
taken before pregnancy to prevent the birth defects. Since
then a survey conducted in 2000 has shown no change in knowledge about
folic acid.
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Q:
Are women getting enough folic acid?
Even
though there are several ways to get 400 micrograms (0.4 milligrams) of
folic acid every day, two thirds of women in the United States do not
consume enough folic acid.
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Q:
What are the costs associated with NTDs?
The
average total lifetime cost to society for each infant born with spina
bifida is approximately $532,000 per child. This estimate is only an
average, and for many children the total cost may be well above
$1,000,000.
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Q:
What are other health benefits to taking folic acid?
High
levels of the amino acid homocysteine are independently associated with an
increased risk of heart disease and stroke. It has been shown that taking
folic acid lowers homocysteine levels in both men and women, but it is not
yet known whether folic acid supplementation also lowers the risk of heart
disease and stroke.
There
are some indications that folic acid use may also reduce the risk for
other birth defects, such as cleft lip and palate and certain congenital
heart defects. Folic acid may also play a role in protecting against some
forms of cancer and heart disease. More research is needed to
understand the impact of folic acid in preventing those diseases and other
birth defects.
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Q.
What if I've already had a pregnancy affected by an
NTD?
If
you have already had a pregnancy affected by NTDs, you are at higher risk
for having another pregnancy affected by NTDs. The U. S. Public
Health Service (USPHS) recommends that you take 400 micrograms (0.4
milligrams) of folic acid every day if you are not planning to
become pregnant. If you plan to become pregnant, you should consult
your health care provider about the desirability of using 4 milligrams
(4000 micrograms) of folic acid daily beginning one month before you start
trying to get pregnant and continuing through the first three months of
pregnancy. Although it appears that a lower dose, such as 0.4
milligrams, may have as great a beneficial effect as 4.0 milligrams, many
health care providers recommend the higher dose. This recommendation
is based on information from a rigorous scientific study involving women
who had previous pregnancies affected by NTDs. This dosage should be
prescribed and monitored by your health care provider. Typically, a
health care provider will prescribe one prenatal vitamin plus three 1 mg
tablets of folic acid a day to get this dosage. You should not take
more than one prenatal or other multivitamin a day to get increased folic
acid, because too much vitamin A can be harmful for the baby. Keep
in mind that we do not understand all the causes of neural tube defects.
We do know that 50%-70% can be prevented by consuming sufficient amounts
of folic acid.
Other
Resources:
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For
parents who have had a child or lost a pregnancy with spina bifida,
anencephaly, or encephalocele, What You Should Know About Folic Acid (English
version). (Spanish
version). This
is a re-creation of a booklet produced by Joleen Viront and Connie
Motter, genetics counselors at Children's Hospital Medical Center at
Akron.
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National
Society of Genetic Counselors.
Go to "International Directory of Genetic Counselors" to
find a genetic counselor in your area.
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Spina Bifida
Association of America. The Recurrence Prevention Program of
the SBAA educates women who have a history of NTDs and health care
providers about the relationship between folic acid and NTDs,
specifically spina bifida. You can download a series of educational
materials from this page.
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