How Folate Can Help Prevent Birth Defects
by Paula Kurtzweil
If you plan to have children some day, here's important information
for the future mother-to-be: Think folate now.
Folate is a B vitamin found in a variety of foods and added
to many vitamin and mineral supplements as folic acid, a synthetic
form of folate. Folate is needed both before and in the first
weeks of pregnancy and can help reduce the risk of certain serious
and common birth defects called neural tube defects, which affect
the brain and spinal cord.
The tricky part is that neural tube defects can occur in an
embryo before a woman realizes she's pregnant. That's why it's
important for all women of childbearing age (15 to 45) to include
folate in their diets: If they get pregnant, it reduces the chance
of the baby having a birth defect of the brain or spinal cord.
"Adequate folate should be eaten daily and throughout
the childbearing years," said Elizabeth Yetley, Ph.D., a
registered dietitian and director of FDA's Office of Special
Nutritionals.
Folate's potential to reduce the risk of neural tube defects
is so important that the Food and Drug Administration requires
food manufacturers to fortify enriched grain products with folic
acid. This will give women one way to get sufficient folate:
by eating fortified breads and other grain products, such as
enriched pasta, rice, waffles and cereal bars.
Other ways to do this are:
- Eat fruits, dark-green leafy vegetables, dried beans and
peas, and other foods that are natural sources of folate.
- Eat folic acid-fortified enriched cereal grain products and
breakfast cereals.
- Take a vitamin supplement containing folic acid.
Nutrition information on food and dietary supplement labels
can help women determine whether they are getting enough folate,
which is 400 micrograms (0.4 milligrams) a day before pregnancy
and 800 micrograms a day during pregnancy.
Neural Tube Birth Defects
The technical names of the two major neural tube birth defects
reduced by adequate folate intake are anencephaly and spina bifida.
Babies with anencephaly do not develop a brain and are stillborn
or die shortly after birth. Those with spina bifida have a defect
of the spinal column that can result in varying degrees of handicap,
from mild and hardly noticeable cases of scoliosis (a sideways
bending of the spine) to paralysis and bladder or bowel incontinence.
With proper medical treatment, most babies born with spina bifida
can survive to adulthood. But they may require leg braces, crutches,
and other devices to help them walk, and they may have learning
disabilities. About 30 percent have slight to severe mental retardation.
The national Centers for Disease Control and Prevention estimate
that about 2,500 infants with spina bifida and anencephaly are
born each year in the United States.
Other maternal factors also may contribute to the development
of neural tube defects. These include:
- family history of neural tube defects
- prior neural tube defect-affected pregnancy
- use of certain antiseizure medications
- severe overweight
- hot tub use in early pregnancy
- fever during early pregnancy
- diabetes.
Any woman concerned about these factors should consult her
doctor.
Folate Link
Scientists first suggested a link between neural tube birth
defects and diet in the 1950s. The incidence of these conditions
has always been higher in low socioeconomic groups in which women
may have poorer diets. Also, babies conceived in the winter and
early spring are more likely to be born with spina bifida, perhaps
because the mother's diet lacks fresh fruits and vegetables--which
are good sources of folate--during the early weeks of pregnancy.
In 1991, British researchers found that 72 percent of women
who had one pregnancy with a neural tube birth defect had a lower
risk of having another child with this birth defect when they
took prescription doses of folic acid before and during early
pregnancy.
Another study looked at folic acid intake in Hungarian women.
The evidence indicated that mothers who had never given birth
to babies with neural tube defects and who took a multivitamin
and mineral supplement with folic acid had less risk in subsequent
pregnancies for having babies with neural tube defects than women
given a placebo.
These studies led the U.S. Public Health Service in September
1992 to recommend that all women of childbearing age capable
of becoming pregnant consume 0.4 mg of folate daily to reduce
their risk of having a pregnancy affected with spina bifida or
other neural tube defects.
That corresponds to FDA's Daily Value for folic acid, which
is 400 micrograms for nonpregnant women, as well as children
4 and older and adult men. For pregnant women, the Daily Value
jumps to 800 micrograms. Daily Values are dietary reference numbers
used on the Nutrition Facts panel on food labels to show the
amounts of various nutrients in a serving of food.
Many women between 19 and 50 consume much less than 400 micrograms
of folate a day, according to the U.S. Department of Agriculture.
Folate Sources
Folate occurs naturally in a variety of foods, including liver;
dark-green leafy vegetables such as collards, turnip greens,
and Romaine lettuce; broccoli and asparagus; citrus fruits and
juices; whole-grain products; wheat germ; and dried beans and
peas, such as pinto, navy and lima beans, and chickpeas and black-eyed
peas.
Under FDA's folic acid fortification program, which became
effective January 1998, the agency requires manufacturers to
add from 0.43 mg to 1.4 mg of folic acid per pound of product
to enriched flour, bread, rolls and buns, farina, corn grits,
cornmeal, rice, and noodle products. A serving of each product
will provide about 10 percent of the Daily Value for folic acid.
Whole-grain products do not have to be enriched because they
contain natural folate. Some of the natural folate in non-whole-grain
products is lost in the process of refining whole grains.
Folate also can be obtained from dietary supplements, such
as folic acid tablets and multivitamins with folic acid, and
from fortified breakfast cereals.
A report recently released by the Institute of Medicine indicates
that the evidence suggests that folic acid, the synthetic form
of folate, may be better absorbed than folate found naturally
in foods. The report also points out that, if taken in adequate
amounts, food folate may eventually be demonstrated to be as
effective as folic acid.
Some Good Sources of Folate
Food |
Serving Size |
Amount (Micrograms) |
%Daily Value* |
Chicken liver |
3.5 oz |
770 |
193 |
Breakfast cereals |
1/2 to 1 1/2 cup |
100 to 400 |
25 to 100 |
Braised beef liver |
3.5 oz |
217 |
54 |
Lentils, cooked |
1/2 cup |
180 |
45 |
Chickpeas |
1/2 cup |
141 |
35 |
Asparagus |
1/2 cup |
132 |
33 |
Spinach, cooked |
1/2 cup |
131 |
33 |
Black beans |
1/2 cup |
128 |
32 |
Burrito with beans |
2 |
118 |
30 |
Pasta |
2 oz. |
100-120 |
25-30 |
Kidney beans |
1/2 cup |
115 |
29 |
Cereal bars |
1 bar |
40-100 |
10-25 |
Baked beans with pork |
1 cup |
92 |
23 |
Lima beans |
1/2 cup |
78 |
20 |
White rice, cooked |
3/4 cup |
60 |
15 |
Tomato juice |
1 cup |
48 |
12 |
Brussels sprouts |
1/2 cup |
47 |
12 |
Orange |
1 medium |
47 |
12 |
Broccoli, cooked |
1/2 cup |
39 |
10 |
Fast-food French fries |
large order |
38 |
10 |
Wheat germ |
2 tbsp |
38 |
10 |
Fortified white bread |
1 slice |
38 |
10 |
* based on Daily Value for folate of 400 micrograms
(Source: Food Values of Portions Commonly Used, 16th edition)
Finding Foods with Folate
Certain information on food and dietary supplement labels
can help women spot foods containing substantial amounts of folate.
Some labels may claim that the product is "high in folate
or folic acid," which means a serving of the food provides
20 percent or more of the Daily Value for folic acid. Or the
label may say the food is a "good source" of folate,
which means a serving of the food provides 10 to 19 percent of
the Daily Value for folic acid. The exact amount will be given
in the label's Nutrition Facts panel.
Some food and dietary supplement labels may carry a longer
claim that says adequate folate intake may reduce the risk of
neural tube birth defects. Products carrying this claim must:
- provide 10 percent or more of the Daily Value for folic acid
per serving
- not contain more than 100 percent of the Daily Value for
vitamins A and D per serving because high intakes of these vitamins
are associated with other birth defects
- carry a caution on the label about excess folic acid intake,
if a serving of food provides more than 100 percent of the Daily
Value for folic acid. FDA has set 1 mg (or 1,000 micrograms)
of folate daily as the maximum safe level. There are limited
data on the safety of consuming more than 1 mg daily, and there
may be a risk for people with low amounts of vitamin B12 in their
bodies--for example, older people with malabsorption problems,
and people on certain anticancer drugs or drugs for epilepsy
whose effectiveness can diminish when taken with high intakes
of folate.
- list on the label's Nutrition or Supplement Facts panel the
amount by weight in micrograms and the %Daily Value of folate
per serving of the product. This information, which appears toward
the bottom of the panel, along with the listing of other vitamins
and minerals, can be used to compare folate levels in various
foods and supplements.
Optional information may appear with the health claim to let
consumers know about other risks associated with neural tube
birth defects, when to consult a doctor, other foods that are
good sources of folate, and other important messages about neural
tube defects.
Other Considerations
The claim about folate cannot imply that adequate folate intake
alone will ensure a healthy baby, since so many factors can affect
a pregnancy.
Women should bear this in mind when contemplating pregnancy,
advises Jeanne Latham, a registered dietitian and consumer safety
officer in FDA's Office of Special Nutritionals. "Folate
can make a significant contribution," she said, "many
factors, including an overall good diet, are involved in having
a healthy baby."
Genetics plays a role, as do other healthful prenatal practices,
such as eating an all-around good diet. But unlike genetics,
diet is a risk factor women can modify to their--and their baby's--advantage,
said Jeanne Rader, Ph.D., director of the division of science
and applied technology in FDA's Office of Food Labeling.
"Folic acid is one of many nutrients needed in a healthy
diet for women of childbearing age," she said. "A well-balanced
diet with a variety of foods can provide all those nutrients,
including adequate amounts of folate."
Women have options for reaching the folate intake goal: They
can get the necessary nutrients and calories both before and
during pregnancy by eating a well-balanced diet, keeping in mind
folate-rich foods, nutrition experts say. Folic acid-fortified
grain products, including breakfast cereals, will help, too.
Dietary supplements are another source of folate. Any one or
a combination of these options for ensuring adequate folate can
help assure women of childbearing age that, if they become pregnant,
their babies will be off to a healthy start.
Paula Kurtzweil is a member of FDA's public affairs
staff.
More Information
For more information on having a healthy baby, contact:
Maternal and Child Health Clearinghouse
5600 Fishers Lane, Room 18A-55
Rockville, MD 20857
(703) 821-8955
March of Dimes Birth Defects Foundation
1275 Mamaroneck Ave.
White Plains, NY 10605
(914) 428-7100
Voice mail only: (914) 997-4750
World Wide Web: http://www.modimes.org/
Publication No. (FDA) 98-2306
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