Are You Taking Your Folic Acid?

Are you taking folic acid? Do you know it’s good for you? Well, maybe not, according the results of a recent SC telephone survey by the SC Birth Defects
Prevention Program. In 2017, the Program conducted a random telephone survey of 1008 women of childbearing years (ages 18-45) to assess their knowledge
of folic acid and use of multivitamins finding that only 30% of women surveyed knew about the importance of folic acid and were taking it regularly.
That is a significant decline from 54% of women in a similar survey done just ten years ago.

Let me back up – for those who aren’t familiar with folic acid – it’s a B vitamin, naturally
present in foods like leafy green veggies, beans and avocados. It’s generally good for you with all sorts of benefits including improved cardiovascular
and mental health. But the main reason to know about folic acid is its ability to prevent birth defects.

In the 1980s, Dr. Dick Smithells, a pediatrician in the UK, discovered that folic acid significantly lowered the risk of recurrence of severe birth defects
of the brain and spine among women who had a previously affected infant. These defects are known as neural tube defects or NTDs (spina bifida, anencephaly,
and encephalocele). It was later demonstrated that women who take a supplement with folic acid can prevent not only a recurrence of NTDs in their future
children, but that low risk women can prevent the first occurrence by taking this vitamin.

Further studies confirmed Dr. Smithells’ work, though for over a decade it was thought by the medical establishment to be too simple of an answer to be
an effective prevention.

In the early 1990s, the utility of folic acid for birth defect prevention was accepted, and the CDC funded prevention programs in both SC and Texas, two
states with a high incidence of NTDs. Through educational outreach programs encouraging all women of childbearing age to take 400 mcg of folic acid
daily (and even more if they had a prior affected pregnancy) the SC program, based at the Greenwood Genetic Center, has reduced the incidence of NTDs
in the state by 60%. Saving millions of healthcare dollars each year and even more importantly, leading to 70 more healthy babies in our state annually.

So back to the survey, if fewer women are taking folic acid, are the rates going back up?

Well, no, and that’s great news! But why not?

Well, there’s more to the story. GGC co-founder, Dr. Roger Stevenson, and others worked with the FDA to mandate the fortification of cereal grain flour
with folic acid. So since 1998, folic acid has been added to breads, pastas, cereals, etc. The amount in the fortification (140 mcg per 100g of milled
flour) doesn’t meet the recommended 400 mcg, but apparently it has been making an impact. So it seems that a combined effect of folic acid supplementation
(with multivitamins) and folic acid fortification (in grains) is doing a pretty good job.

However, while the rate of NTDs has declined significantly thanks to folic acid, there are still some potentially preventable NTDs occurring, so we can’t
rest. We are still focused on educating women about the importance of folic acid. That’s where the telephone survey comes in. here’s what we learned…

• Black women were least likely to have heard of folic acid (44%, compared with 59% of white women and 48% of women of other races)
• Age effects – Women over 30 were more likely to know about the protective benefits of folic acid and those 30-39 were most likely to be taking supplements
  (71%). The lowest rate of supplementation (14%) was in women 40 and older.
• Education was a factor – Women with education beyond high school were more likely to know about folic acid and much more likely to be taking a supplement
  (69%) compared with those with a high school education (24%). Only 7% of those with less that a high school education used folic acid supplements.
• For those who did know about folic acid, the majority (55%) had learned it from their healthcare provider, compared to just 26% in the earlier years
  of the program.
• Additional data from a different 2017 study by the March of Dimes showed that most women knew that folic acid was important for the health of the baby,
  but did not know when to take it, how much to take, or why it was important.
• But even more, lots more, of those polled in the SC survey knew about the Zika virus and its association with birth defects, most notably, microcephaly
  or small head size. Of course Zika is a newer risk and has gotten a great deal of press in the past year. As expected most women (80%) had heard
  of Zika, and 70% knew of its association with birth defects. Of those who knew about the virus, most (60%) learned about it from television.

So how does this help?

We’re getting the message out to healthcare providers to share this with their patients. We target these providers with information and resources to share
and will continue to do so. This data also helps us get an idea of which populations that our message has been missing, so we can adjust accordingly,
as well as specifically what kinds of information (dosage, timing, etc.) they are lacking.

As we celebrate Birth Defects Awareness Month every January, we look to refine our role – how can we best get this life-saving message out to those who
need it most. We resolve, as 2018 begins, to continue with what’s working and to adapt and fill the gaps ensuring that fewer families are touched by
these preventable birth defects.

For more information about folic acid or the SC Birth Defects Prevention Program, contact Jane Dean, RN at jane@ggc.org or 1-800-676-6332.