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FOLIC ACID EQUALS HEALTHY BABIES
HELPING HISPANIC WOMEN HAVE HEALTHY BABIES

According to the March of Dimes, in the United States about 2,500 infants are born each year with a neural tube defect. Neural tube defects are major birth defects that affect a baby’s brain or spinal cord. The majority of these birth defects could be eliminated simply by women getting enough of the vitamin folic acid.

The two most common forms of neural tube defects are spina bifida and anencephaly. They are among the most serious and common birth defects to cause infant mortality, morbidity and disability. According to the CDC, the average cost of caring for a child born with spina bifida is about $636,000, but for some children the costs can be as high as $1 million. The annual medical care and surgical costs for persons with spina bifida in the United States exceed $200 million.

Neural tube defects occur in about one out of every 2,000 live births in the United States, but not all races and ethnic groups are affected equally. Hispanic women in the United States have 1.5 to 2 times higher risk of having a baby with a neural tube defect than non-Hispanic whites. However, daily consumption of folic acid before and during early pregnancy can prevent up to 70 percent of these birth defects.

Neural tube defects occur in the first month of pregnancy, before many women know that they are pregnant. Since 50 percent of pregnancies are unplanned, it is critically important that all women of childbearing age (especially teens, who have the highest rate of unplanned pregnancy) get enough folic acid—not just those planning to become pregnant. Currently, half of all Hispanic teens become pregnant by age 20 and they have the highest teen birth rate among major racial/ethnic groups.

The Centers for Disease Control and Prevention (CDC) and the U.S. Public Health Service recommend that women of childbearing age consume 400 micrograms (mcg) of the B vitamin folic acid every day as part of a healthy diet – whether they are pregnant or not. This may be the easiest way to decrease the number of infants born with neural tube defects. For Hispanic women, however, there are some challenges when it comes to making sure they get enough folic acid. Hispanic women have lower blood folate levels and are less likely to consume foods fortified with folic acid. Also, Hispanic women are less likely to have heard about folic acid or know that it can prevent birth defects, and are less likely to take vitamins or eat foods fortified with folic acid before pregnancy.

Should folic acid be taken before pregnancy in order to prevent birth defects? Yes!

What are Folate and Folic acid?

Folate is the naturally occurring form of a B vitamin (B9) found in a variety of foods such as leafy green vegetables (like kale and spinach) ,fruits (like citrus fruits and juices), and dried beans and peas. Folic acid is the synthetically manufactured form of the same vitamin and is found in supplements and added to foods such as fortified breakfast cereals.

When and why should folic acid be taken? Women can reduce the risk that their baby will be born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70% by taking folic acid daily prior to conception and during early pregnancy. The B9 vitamin is crucial in the development of DNA, and as a result, folic acid plays a large role in cell growth and development, as well as tissue formation.

What birth defects are prevented by taking folic acid? Folic acid prevents neural tube defects. The two major neural tube defects are: (1) spina bifida (an incomplete closure of the spinal column) and (2) anencephaly (a severe underdevelopment of the brain.) These defects occur during the first 28 days of a pregnancy- usually before a woman knows she’s pregnant. Spina bifida is a crippling condition that affects the spine and brain of a newborn baby that can cause paralysis of the lower body, loss of bowel or bladder control and learning disabilities. Children born with anencephaly die shortly after birth because most or all of the brain is absent.

What does CDC recommend to prevent neural tube birth defects? CDC recommends that women of childbearing age--especially those planning a pregnancy--consume 400 micrograms (0.4 milligrams) of folic acid every day through their dietary intake and/or vitamin supplements. Getting an adequate level of folic acid daily is important for at least one month before conception and three months afterward to reduce the potential risk of having a fetus with a neural tube defect.

Getting Enough Folic Acid?

Sources of folic acid. Women can assure that they get the recommended allowance of folate/folic acid by eating enriched grain products, certain vegetables and fruits, or by taking dietary supplements. Folate/folic acid is found in the following foods:
· Orange juice -- just one 8-ounce glass provides about 25% of the recommended daily dose of folic acid
· Green vegetables like kale, spinach, romaine lettuce, beans, broccoli, and asparagus
· Lentils, black beans, peas, and peanuts (Note: Be careful of peanut allergy)
· Breakfast cereals that say "fortified" on the box (such as Total and Product 19)
· Rice, pasta and breads that say "enriched" on the label

Trying to get the daily folic acid requirement from foods alone is difficult. To reach the recommended daily allowance, a vitamin supplement probably will be needed, according to Steve Abelman, March of Dimes, who also sits on the leadership committee of the National Council on Folic Acid. Some health care providers recommend their patients take a folic acid supplement in addition to their regular prenatal vitamin. A woman should consult with her health care provider to determine what is best to meet her needs. The CDC recommends that women consume no more than 1,000 micrograms of folic acid vitamin supplements each day.

Folic acid is good for dad too! Folic acid is not just important for the health of women and moms-to-be. Men also can benefit from more in their diet, because it plays an important role in the production of normal red blood cells. Recent studies suggest that folic acid plays a significant role in the prevention of heart disease, stroke and certain cancers, especially colon cancer, although more research is needed to confirm these effects.

Federal and State Initiatives
Arizona State Rep. Amanda Aguirre, whose district is along the border with Mexico, uses her experience as a registered dietician to focus on nutritional issues affecting her constituents including those that affect teen pregnancies. “In order to improve pregnancy outcomes among teens, introduction of folic acid education early in their formal education is necessary,” she said. The impact of early education (on a national, state and local level) and the importance for both males and females to include folic acid in their diet on a daily basis is crucial, she stressed. The success in fortifying cereals and other foods with folic acid makes folic acid widely available through diet. The high rate of unintended pregnancies necessitates the need for education and the availability of folic acid in many traditional and nontraditional foods.

In 2000, Congresswoman Lucille Roybal-Allard (CA) recognized the need for a national campaign to educate women about the benefits of folic acid. She sponsored a bill directing the Centers for Disease Control and Prevention to start a public education campaign on folic acid. President Clinton signed the bill into law in the fall of 2000 as part of the comprehensive Children's Health Act. The Act included several provisions to improve the health of infants and children by preventing birth defects. The Act:
· Created a National Center on Birth Defects and Developmental Disabilities at CDC to advance research and prevention of birth defects and developmental disabilities;
· Authorized a newborn screening initiative, an important step in giving states the resources they need to improve and expand newborn screening; and
· Authorized the CDC to conduct a comprehensive national education campaign to raise awareness of folic acid.

The CDC, March of Dimes and National Council on Folic Acid (NCFA) are partners in a national effort to promote folic acid for the prevention of serious birth defects. The joint effort aims to reach every woman who could become pregnant, health care professionals and community advocacy groups to educate them on the importance of folic acid in the daily diet. Educational messages, materials, Web sites and other tools on folic acid were created in both English and Spanish.

One of the biggest successes of the initiative was its work with the FDA on a folic acid fortification program. The fortification regulations, which became effective in 1998, require manufacturers to include folic acid at the level of 140 micrograms/100 grams in enriched grains such as breads and pastas. Manufacturers will be allowed to make claims on the labels that the fortified products contain folic acid and that adequate intake of the nutrient may reduce the risk of neural tube defects. These efforts helped reduce the occurrence of neural tube defects by 27%.

The CDC also ran a Spanish-language Folic Acid Campaign in select cities with high Hispanic populations from 2001 through 2005. The goal of this campaign was to increase folic acid awareness, knowledge, and consumption among Hispanic women of childbearing age to reduce their risk of having a pregnancy affected by a neural tube birth defect. The campaign used a combination of Spanish-language radio and television and interpersonal communications using “promotoras” (community health workers) to reach this population. Preliminary results from the campaign show an increase in awareness, knowledge and consumption of folic acid among Hispanic women in the selected cities. Currently, the CDC is evaluating the effectiveness of existing campaign materials and messages and will conduct a series of focus groups and one-on-one interviews with Hispanic women.

Additionally, the Birth Defects and Developmental Disabilities Prevention Act of 2003, an expansion of the Birth Defects Prevention Act of 1998, provides federal funding to help states develop, implement or expand community-based initiatives to track the incidence of birth defects, educate families and health care providers on how to prevent birth defects, and improve access to health services for children living with birth defects. The bill authorizes appropriations through FY 2007.

Finally, the National Alliance for Hispanic Health offers a National Hispanic Prenatal Helpline for Hispanic consumers to call from anywhere in the nation and speak to bilingual health information specialists who can provide a referral to a culturally and linguistically proficient prenatal care provider in their community. Bilingual fact sheets on numerous topics have been developed to address all aspects of prenatal care and bilingual helpline staff is available to answer questions on prenatal care.

Conclusion

Since only 50% of all pregnancies are planned, it is recommended that any woman who could become pregnant consume enough folic acid to prevent birth defects-- not just those planning to become pregnant. State solutions to this public health issue, particularly in Hispanic communities, that can have a positive impact on birth defects include making foods rich in folic acid available in schools and providing education programs on the importance of folic acid.

Since not every state has a birth defect registry, Beverly Robertson, National Director for Pregnancy and Newborn Health Education Center, March of Dimes, suggests that legislators advocate for data collection systems that look at infant morbidity and incidences of birth defects in every state. Finally, attention to this important issue can be highlighted on the state level by declaring National Folic Acid Awareness Week, which is January 8 – 14, 2007.

FACTS

According to the 2005 March of Dimes Gallup survey:

· 84% of women reported knowing about folic acid - up from only 78% in 2004.

· Only 33% of women of childbearing age reported taking folic acid every day in a specific folic acid supplement, prenatal vitamin, or multivitamin, down from 40% in 2004.

· In both 2004 and 2005, only about 25% of women knew that folic acid prevented birth defects,

· Only 7% of women knew that folic acid should be taken before pregnancy, down from 12% in 2004.

End Notes
March of Dimes. Acessed from http://www.marchofdimes.com/professionals/14332_1224.asp .
National Council on Folic Acid, “Hispanic Babies at Higher Risk for Birth Defects,” (May 2006). Accessed from http://www.folicacidinfo.org/detail.php?id=200&type=news
The National Campaign to Prevent Teen Pregnancy. Campaign Update, Winter 2006.
4 CDC. Spina Bifida and Anencephaly Before and After Folic Acid Mandate-United States, 1995-1996 and 1999-2000. MMWR 2004. 53:17; 362-365. Accessed from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm

Resources
CDC National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/

March of Dimes
http://www.marchofdimes.com and www.nacersano.org
National Alliance for Hispanic Health - La Línea Nacional Prenatal Hispana
http://www.hispanichealth.org
National Alliance for Hispanic Health - Su Familia: The National Hispanic Family Health Helpline
E -mail: SuFamilia@hispanichealth.org; http://www.hispanichealth.org
KidsHealth for Parents (English and Spanish)
http://kidshealth.org/parent/en_espanol/index.html

March of Dimes. Acessed from http://www.marchofdimes.com/professionals/14332_1224.asp .

National Council on Folic Acid, “Hispanic Babies at Higher Risk for Birth Defects,” (May 2006). Accessed from http://www.folicacidinfo.org/detail.php?id=200&type=news

The National Campaign to Prevent Teen Pregnancy. Campaign Update, Winter 2006.
4 CDC. Spina Bifida and Anencephaly Before and After Folic Acid Mandate-United States, 1995-1996 and 1999-2000. MMWR 2004. 53:17; 362-365. Accessed from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm

Resources
CDC National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/

March of Dimes
http://www.marchofdimes.com and www.nacersano.org
National Alliance for Hispanic Health - La Línea Nacional Prenatal Hispana
http://www.hispanichealth.org
National Alliance for Hispanic Health - Su Familia: The National Hispanic Family Health Helpline
E -mail: SuFamilia@hispanichealth.org; http://www.hispanichealth.org
KidsHealth for Parents (English and Spanish)
http://kidshealth.org/parent/en_espanol/index.html

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This article was written by the National Hispanic Caucus of State Legislators (NHCSL. NHCSL) is the preeminent organization representing the interests of 300 Hispanic state legislators from all states, commonwealths, and territories of the United States. Founded in 1989 as a nonpartisan, nonprofit 501(c)3, NHCSL is a catalyst for joint action on issues of common concern, such as health, education, immigration, homeownership and economic development to all segments of the Hispanic community. For more information visit www.nhcsl.org June 2006