Folic acid

Monday February 1, 2016

I thought that I would use this space to update/inform people about folic acid and the relationship to the development of spina bifida and why it remains an issue for families today.

The neural tube (brain and spinal cord) closes by day 26 after conception; this is prior to most women recognizing that they are pregnant.  Although it is not understood why folic acid is important for the development of an intact spinal cord it is thought that because it is a time of rapidly dividing cells in the neural tube the developing baby probably requires a large amount of folate for this to occur completely.  Based on this information the recommendation was made to try to increase the amount of folic acid that women of child bearing age consume.  In 1992 the U.S. Public Health Service recommended that all women of childbearing age consume 400 mcg (microgram) of folic acid daily thru supplementation and diet.   The message was not reaching most women prior to conception so mandatory fortification of cereal/ grain products with folic acid was authorized in 1996 and fully implemented in 1998.  This program primarily fortifies grain products not corn and rice based items in the US. Fortification programs exist in the US, Canada, Costa Rica, Chile and South Africa (as of 2011), although most countries have adopted the recommendation to consume 400 mcg/day of folic acid.  The number of children diagnosed with neural tube problems in the US has declined by 30+% per the CDC since the fortification program started.  Clearly there are children born with spina bifida and other neural tube issues.  It is known that there are other risk factors for developing spina bifida like taking the medication Depakote prior to pregnancy, having diabetes, certain genetic issues affecting a mother’s folate levels and genetic causes that are not yet identified.

For women that have had a child with spina bifida without any other risk factors they are at an increased risk, therefore U.S. Public Health Service guideline recommends  taking 4 mg (milligrams) (4, 000mcg) of folic acid daily beginning one month before they start trying to get pregnant and continuing through the first three months of pregnancy.     The Institute of Medicine has studied the safety of folic acid and found that even at dosages of 15,000–100,000 mcg of folic acid daily there was limited evidence of direct toxicity of folic acid. With the higher level of supplementation the risk for having a child with a neural tube issue is greatly reduced.

I bring up this topic to raise awareness for the mothers of children with spina bifida that are considering having another child, women with spina bifida of child bearing age and for the sisters/aunts of people with spina bifida that are of child bearing age and sexually active .  If you or anyone you know of has concerns about this topic or needs more information please speak with your health care provider.

this information was from an article published by Nutrients. 2011 Mar; 3(3): 370–384. Folic Acid Food Fortification-Its History, Effect, Concerns and Future Directions, authors Krista S Crider, Lynn B Bailey and Robert J Berry,  the Center for Disease Control and Prevention web site and the American Academy of Pediatrics.