Only a fraction of women of childbearing age are taking a government-recommended nutritional supplement that would significantly reduce the risk of major birth defects, according to a recent report published by the Centers for Disease Control and Prevention.
The lack of preventive measures by women leads to billions of dollars in medical and social costs for the infants and their families. For instance, one in every 33 infants is born with some kind of physical or mental defect, the California Birth Defects Monitoring Program reported.
The nation's Public Health Service recommended three years ago that females 18 to 45 years old consume 0.4 mg of folic acid daily in the form of a supplement, fortified breakfast cereal or in foods rich in the Vitamin B compound. The U.S. Food and Drug Administration estimates that women in this age range consume only 0.2 mg of folic acid each day.
Yet fewer than one in four is actually following such a dietary program, and most of those are doing so inadvertently or unknowingly by taking a multivitamin or eating a cereal that happens to be fortified with folic acid along with several other compounds, according to the CDC's Morbidity and Mortality Weekly Report.
Research has found that daily folic acid intake by women before conception--and during early pregnancy--can reduce the risk of spina bifida and anencephaly by at least 50%. (Spina bifida is a congenital neural tube defect of the spine; anencephaly is a neural tube defect of the brain.)
The simple preventive health measure of folic acid supplementation is still not known to most women.
"This finding represents a historic opportunity for the prevention of birth defects," CDC said.
The two conditions are among the leading causes of birth defects and afflict about 2,500 infants each year in this country with an estimated health care cost of about $500 million. Infants with anencephaly die almost immediately after birth. Another 1,500 fetuses discovered prenatally to have the conditions are also aborted annually.
The CDC reported on an opinion survey, conducted for the March of Dimes Brith Defects Foundation, that found "only 25% of non-pregnant women in the United States regularly consumed a vitamin supplement containing 0.4 mg folic acid and only a small proportion ate a breakfast cereal containing 0.4 mg folic acid per serving." The poll has a margin of error 2%.
Of the women who were found to be taking prenatal supplements, only 6% knew that folic acid was "especially important" to future fetal development. Iron, calcium and multiple vitamins were thought to be more important, according to the responses.
Other highlights from the survey of 2,010 women:
* Eighty-eight percent of those surveyed correctly said that the risk of birth defects can be reduced. Yet when asked what were the best ways of reducing the risk, only 1% said by consuming folic acid.
* Only 20% of the women surveyed reported taking recommended vitamins before pregnancy.
* Most women do not take vitamins before or during pregnancy, the survey found. The reasons for avoiding supplements vary: 22% said they don't need them, 18% responded that they forget to take them and 12% stated that they get balanced nutrition from foods.
The CDC said there remains an urgent need to educate women of childbearing age in the importance of folic acid through information distributed by the media, physicians' offices, clinics, schools and health clubs.
Natural sources of folic acid include dark-green leafy vegetables (spinach, broccoli, lettuce); citrus fruit and juices; wheat germ; liver; kidneys and dried beans.
The importance of the issue for women has prompted the U.S. Food and Drug Administration to propose that enriched cereal grain products (bread, flour, rolls, buns, rice, pasta) be required to also contain folic acid.
"Since more than half of pregnancies are unplanned, FDA [proposes] to fortify food so that all women of childbearing age get a daily does of folic acid," the agency reported.
The FDA cautioned that there is a danger for some groups, particularly people 65 and older, of consuming too much folic acid, or more than 1 mg per day. Elevated folic acid consumption can mask the symptoms of pernicious anemia.
Folic acid is also believed to be effective in preventing cleft lips and palates by 25% to 50%, according to the California Birth Defects Monitoring Program. There are an estimated 7,000 cases nationwide of these birth defects, which often require several rounds of surgery during the infants' first two years.
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Too Much of a Good Thing
In another development last week, researchers at the Boston University School of Medicine found that women who take elevated doses of Vitamin A during the early stages of pregnancy may place their infants at increased risk of birth defects ranging from cleft lips to severe heart problems.
The risks were most likely in women who consumed more than 10,000 IU (international units) of Vitamin A in multiple vitamins or single Vitamin A supplements. As a result, the March of Dimes recommends taking multiple vitamins that contain no more than 5,000 IU of Vitamin A and against taking supplements containing only Vitamin A. The organization also notes that beta carotene can be substituted for Vitamin A.