Folic acid prevents birth defects

Dr. Michael Caldwell
For the Poughkeepsie Journal

The Zika virus has received a lot of attention lately especially now that it has entered the United States. We have learned that infection with the virus leads to an increased risk of having babies born with abnormally small heads, also known as microcephaly. Did you know that birth defects also could be caused by the deficiency of vitamin B-9, also known as folate or folic acid?

January is National Birth Defects Prevention Month and this week, Jan. 8-14, is Folic Acid Awareness Week.

Prepare for a healthy pregnancy

I remember a lecture in medical school when one of my teachers proudly showed off a picture taken of him at a recent wedding he attended.  In it he presented an unusual nuptial gift, a bottle of vitamins containing folic acid! The message to this young bride was clear, women must prepare for pregnancy before becoming pregnant. Researchers have found that women need 400 micrograms (mcg) of folic acid every day. The CDC tells us that if a woman has enough folic acid in her body before and during pregnancy, it can help prevent major birth defects of the baby’s brain and spine, also known as neural tube defects.  These defects are known specifically as spina bifida and anencephaly. There are about 1,500 babies born with spina bifida and 1,200 babies born with anencephaly in the United States each year. Across the world it is estimated that more than 300,000 babies are born with neural tube defects each year.

“Women can never start too early in planning for a healthy baby,” said Michael Warren, MD, MPH, Tennessee Department of Health assistant commissioner of Family Health and Wellness. “By the time many women learn they are pregnant, much of their baby’s important development is already underway. All of our organs start to develop between four to eight weeks and some women may not know they are pregnant until after that time. It is incredibly important for women of child-bearing age to make healthy lifestyle and behavior changes before they become pregnant, reducing the likelihood of preventable birth defects if they become pregnant.”

Folic acid supplements are a key way you can prepare yourself and your new baby for a healthy birth day. Since most pregnancies are unplanned, the CDC recommends that all women between the ages of 15 and 45 make sure they get the recommended 400 micrograms of folic acid each day.

Why folic acid?

Every cell in your body needs folic acid for normal growth and development. It also helps your body make red blood cells that carry oxygen from your lungs to all parts of your body to keep you healthy and strong. Folic acid was initially named in 1941 after it was isolated from spinach. Another influential professor of mine from Mount Sinai School of Medicine, Dr. Victor Herbert, performed a famous experiment in 1961 in which he ate a folate-deficient diet for four months and showed that folate was directly tied to his becoming anemic. There have been a number of other landmark studies that have shown how folic acid helps to prevent neural tube birth defects. Research is ongoing to better understand the value of folic acid and other micronutrients and how they may impact birth defects. Some of the most prominent studies that continue are the National Birth Defects Prevention Study, the National Health and Nutrition Examination Survey (NHANES) and the U.S.-China Collaborative Project between our CDC and the Peking University Health Science Center (PUHSC).

Folic acid fortification in our food supply

Many foods naturally contain folate, the natural version of folic acid. Some of these are dark leafy greens, such as spinach and collard greens. You will also naturally find folate in asparagus, broccoli, citrus fruits, beans, peas and lentils; avocados, okra and Brussels sprouts.

Michael Caldwell

We have learned it is not enough to rely on the natural food supply to assure everyone is getting adequate folic acid. Not everyone has access to these foods, gauge their intake or are able to take vitamin supplements. Recently, the U.S. has required parts of our food supply be fortified with folic acid as a major public health initiative.

Beginning in 1998, the United States mandated fortification of enriched cereal grain products with 140 µg of folic acid per 100 g. The CDC has noted that immediately after mandatory fortification, the birth prevalence of neural tube birth defect cases declined. Fortification is estimated to avert approximately 1,000 NTD-affected pregnancies annually in the U.S. Look for the word “fortified” or “enriched” on the package label and look carefully at the FDA food label to know if your food has added folic acid. Foods now with added folic acid in the U.S. include:  bread, breakfast cereals, cornmeal, flour, pasta and white rice. Just within the last year the FDA approved fortifications in corn masa (the Spanish word for “dough”), which is a common ingredient in our Latino kitchens.

Although mandatory folic acid fortification has been an effective public health intervention, we still have more work to do to assure everyone is receiving as much folic acid as they need and to further reduce the prevalence of neural tube birth defects in the United States.

Dr. Michael Caldwell is the former Dutchess County Commissioner of Health. Send comments to; Twitter: @healthchief

On the web

Find additional information on folic acid at the following websites:


March of Dimes:

National Birth Defects Prevention Network:

American Pregnancy Association: