It's been seven years since federal health officials announced that folic acid was so effective at preventing a certain type of birth defect that all women of childbearing age should take it.
Last year, the government even mandated that cereal and grain products be fortified with folic acid--a form of vitamin B--to prevent neural tube defects, which involve the spinal cord. Now, however, public health leaders are facing the unsettling realization that none of their efforts have worked to prevent this serious type of birth defect.
The failure of women and their doctors to embrace the folic acid message has perplexed health officials, who say that as many as 2,000 to 2,800 cases of neural tube defects (out of the estimated 4,000 a year) could be avoided in the United States if all women of reproductive age consumed enough folic acid.
"Five years ago, we thought that if we just told people about it, they would naturally take it. We thought that would be enough," says Judith S. Gooding, director of the March of Dimes' folic acid campaign.
Women and their doctors may not realize that folic acid is only effective if taken in the first few weeks of pregnancy, before a woman even knows she's pregnant, Gooding says. For this reason, it's important for all women of reproductive age to consume 0.4 milligrams (or 400 micrograms) of the vitamin routinely in case they become pregnant. About half of all pregnancies are unplanned.
The Problem Is Getting Folic Acid Into Women
Getting enough folic acid through diet is extremely difficult, requiring women to eat several cups of foods high in folic acid each day. But getting women to take a vitamin every day--often for years and even if pregnancy is not on a woman's radar screen--has also proved to be an enormous challenge.
"The fact that we know how to prevent this defect hasn't had an effect," says Charlotte Dickinson, a researcher and expert on birth defects for the Centers for Disease Control and Prevention in Atlanta. "The real problem is getting people aware of what is going on."
Neural tube defects occur 18 to 28 days after conception. During this period, the small collection of fetal cells, which begins to grow as a flat patch, folds over and curves, with the edges forming what will be the spinal cord.
If the top of the spinal cord fails to close, a baby is born without a brain, a condition called anencephaly. This results in stillbirth or death within a day or so.
