Estimated Time:  40 minutes

Folic acid is a B-vitamin the body needs for healthy cells and healthy blood. Studies show that 50% to 70% of neural tube birth defects (NTDs) can be prevented if women take folic acid before and during pregnancy.    

Many times, folic acid is referred to as folate.  Is there a difference between folate and folic acid?  The answer is yes, there is a difference. Both are forms of the same B-vitamin, but they come from different sources. 

     
Folate is found naturally in foods such as dark-green leafy vegetables (spinach, collard greens, turnip greens, and romaine lettuce), broccoli, asparagus, beans, peanuts, strawberries, kiwi, liver, orange juice, and other food items.  On average, women in the United States get about 200 micrograms of folate from food each day.

Folic acid is man-made. It is the form of the vitamin that is added to breakfast cereals, enriched grain and cereal products (bread, rice, pasta), and in most multivitamin pills.  

Cereals that have of folic acid per serving include:  Whole Grain Total®, Total Corn Flakes®, Total Raisin Bran®, Smart Start®, Multi-Grain Cheerios Plus®, Just Right with Crunchy Nuggets®, and Product 19®.   Many cereals have 100 micrograms or 25% of the folic acid needed each day to prevent birth defects.  To find out how much folic acid is in foods you buy, look at the "Nutrition Facts" label on the package.

Activities

Make a collage of pictures of good sources of folic acid or folate.

Look in cabinets at home to find 10 food items that are enriched with folic acid.  Make a list and bring it to class.

Create a plan for 1 day's meals that includes 400 micrograms of folic acid (without eating a cereal with 400 mcg of folic acid per serving).  To find the amount of folic acid in foods go to the U. S. Department of Agriculture site at www.nal.usda.gov/fnic/foodcomp.

Group Discussion  Which do you think would be easier for the body to absorb and use, folate or folic acid?  Why?

It might surprise you that folic acid added to foods and vitamins pills is easier for the body to use than the folate naturally in foods.  Cooking the food, as well as exposure to light and air, can destroy the folate in foods.  Since it is hard to get enough folate from foods, in 1998 the Institute of Medicine (a group of health and nutrition experts) announced that women who could get pregnant should take 400 micrograms of folic acid every day.  People should take folic acid (in enriched foods or supplements) and have a healthy, varied diet.  

Enriching the food supply

To enrich or fortify a product means to add vitamins or minerals to it.  In the U. S., iodine is added to some salt.  Extra vitamins and iron are added to grain and cereal products to keep us healthy.  The Food and Drug Administration (FDA) is the government agency that makes the rules to protect the safety of the foods we eat and the drugs we can take.  In January 1998, a law went into effect to add folic acid to grain and cereal products, and the FDA makes sure this happens.  Some of the foods that now have extra folic acid include pasta, bread, flour, breakfast cereals, and rice.  Still, most females ages 13-45 years do not get enough folic acid every day.  To get enough folic acid through enriched foods every day you would need to eat a whole loaf of bread; or four servings of most cereals;  or 3.5 servings of pasta; or 10 servings of rice.  Still most women and teens will need to plan their meals to get enough folic acid every day from enriched foods.

Small Group Activity 

Teachers, print off the blank form and create a transparency or use a chalk board to fill in the blanks. 

Imagine that you and all the students in the class are members of the National Council for Nutrition and Health.  You are meeting to make sure that all women who could get pregnant receive 400 micrograms of folic acid or folate every day.  There are three main options that could be tried. 

1. One option is to enrich (fortify) food.  To enrich food means to add small amounts of the vitamin to food products--sometimes salt and flour are enriched. 

2. A second option is to urge women to consume vitamin pills that contain the recommended amount. 

3. The third option is to try to change the eating habits of women so that they will eat more foods with folic acid and folate. 

Complete the chart and discuss the pros and cons of each of the three options. Example discussion topics are provided below. Discuss which options would be better accepted, and if there are costs involved, or education and behavior change needed.  Remember, if all women who could get pregnant consume 400 micrograms of folic acid every day, 50%-70% of neural tube defects could be prevented.  

The student may have other ideas about the advantages and disadvantages of the three options.  If they ask, folic acid is not likely to cause an allergic reaction, is not addictive, and is not toxic.  Extra folic acid leaves the body through urine.

It is important for women to take 400 micrograms of folic acid every day before pregnancy because:

• In the U. S., half of women who get pregnant did not expect to get pregnant.

• NTDs occur during the first month of pregnancy when most women don't know they're pregnant.  That is the most important time to prevent serious birth defects.

Because the fortification levels are not high enough for all women to get enough folic acid from foods, many groups in the U. S. are teaching women to take vitamin pills with folic acid, and to eat a balanced diet with enriched foods every day.  The CDC, March of Dimes, and Spina Bifida Association have developed materials to educate women about folic acid.  You may be able to view some of the public service announcements (PSAs) on TV, or get a copy from a local March of Dimes office. 

Group Discussion

If you are able to find one of these PSAs, discuss it in class.

        What is the main idea of the PSA?
        Who is this message meant for? 
        Is this believable?
        What did you like about the message?
        What new facts did you learn?
        Where would you like to see this played?

You can order posters and brochures from the CDC at: 

http://www2.cdc.gov/ncbddd/faorder/orderform.htm

or call 1-888-232-5929

In the U. S., two thirds of women who could get pregnant do not get enough folic acid everyday.  Also, only 7% of women know that folic acid is needed before pregnancy.  Because most women do not get enough folic acid through foods, they should take a vitamin pill with folic acid or eat foods enriched with folic acid, as well as eating fruits and vegetables with high amounts of folate.

Researchers are looking at other advantages of folic acid besides preventing birth defects.  Some researchers believe that folic acid may help prevent some heart attacks, strokes, Alzheimers disease, and some cancers later in life.

Individual Activity  

Write down what YOU can do to help women take folic acid.

Small Group Activity   

Design an educational poster, song/tune/jingle, or commercial idea to tell women about folic acid.

Individual Activity  

Ask each of your students to write on an index card or piece of paper something they learned from the "Title" Folic Acid module.

Link to:  Going Beyond--Ideas to Integrate

In some school districts, this information below may have to be approved before use.

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This page was last updated Wednesday, January 28, 2004

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National Center on Birth Defects and Developmental Disabilities

The National Center on Birth Defects and Developmental Disabilities (NCBDDD) promotes the health of babies, children, and adults, and enhance the potential for full, productive living.  Our work includes identifying the causes of birth defects and developmental disabilities, helping children to develop and reach their full potential, and promoting health and well-being among people of all ages with disabilities.