FOLIC ACID: For The Future

This presentation was developed by the Missouri Department of Health and SeniorServices through a grant from the Centers For Disease Control and Prevention

FOLIC ACID:FOLIC ACID:For The FutureFor The FutureFOLIC ACID:FOLIC ACID:For The FutureFor The Future

Missouri Department of Health and Missouri Department of Health and Senior ServicesSenior Services

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Course OutlineCourse OutlineCourse OutlineCourse Outline

What is folic acid?How do you get folic acid?Who needs folic acid?How do neural tube defects occur?What is a neural tube defect?What are the recommended levels of folic

acid?What can you do?

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What Is Folic Acid?What Is Folic Acid?What Is Folic Acid?What Is Folic Acid?

Folic acid is the synthetic form of a water soluble B vitamin that is needed to:

Make new cells/cell divisionMake normal-shaped red blood cellsHelp prevent anemiaHelp prevent birth defectsHelp prevent heart disease, stroke and certain

cancers.

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How Do You Get Folic Acid?How Do You Get Folic Acid?How Do You Get Folic Acid?How Do You Get Folic Acid?

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Foods Naturally High in Folic Acid Foods Naturally High in Folic Acid Foods Naturally High in Folic Acid Foods Naturally High in Folic Acid

Liver Nuts and peanut butter Dried peas or beans Juices: orange,

pineapple, tomato Fruits: orange,

avocado, cantaloupe Leafy green

vegetables

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Fortified Grain ProductsFortified Grain ProductsFortified Grain ProductsFortified Grain Products

Just right with crunchy nuggets

Multi-grain cheerios plus Product 19 Special K Whole grain total Total corn flakes Total raisin bran

SOME of the cereals with 100% of the recommended daily value of folic acid per serving:

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Easiest Way!Easiest Way!Easiest Way!Easiest Way!

Take a multi-vitamin with 400 mcg. of synthetic folic acid every day

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Who Needs Folic Acid?Who Needs Folic Acid?Who Needs Folic Acid?Who Needs Folic Acid?

All women aged 14-50 who COULD become pregnant

Pregnant womenEveryone,

including men

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How Do NTDs Occur?How Do NTDs Occur?How Do NTDs Occur?How Do NTDs Occur?

Baby’s brain and spine fail to close completely

Neural tube closing properly to form spinal column and brain.

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What Is a Neural Tube Defect?What Is a Neural Tube Defect?What Is a Neural Tube Defect?What Is a Neural Tube Defect?

Spina Bifida – 60%Anencephaly – 30%Encephalocele – 10%

Neural tube defects (NTDs) are the second most common cause of infant mortality.

NTDs occur in 1 out of every 2,000 babies.

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AnencephalyAnencephalyAnencephalyAnencephaly

Upper end of the neural tube fails to close

Brain either never develops or is totally absent

50% stillbirth rate Usually fatal, 5%

survive one week

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EncephaloceleEncephaloceleEncephaloceleEncephalocele

Defect of the skull – smaller defect than anencephaly

Protrusion of brain or skin-covered brainRarer than the other types of NTDsOverall mortality rate about 29%

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Spina BifidaSpina BifidaSpina BifidaSpina Bifida

Neural tube fails to close Neural tube fails to close properly:properly:• Occurs by 28 gestational

days Associated problems:Associated problems:

• Hydrocephalus• Clubfoot• Vertebral anomalies• Renal anomalies

Requires surgery 24-48 Requires surgery 24-48 hours after birthhours after birth

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Financial CostsFinancial Costs:: Average estimated lifetime cost of $532,000 for each infant born with spina bifida (CDC 1999) adds an estimated 19 million dollars every year to Missouri resident lifetime costs associated with spina bifida.

Physical CostsPhysical Costs:: Possible paralysis (the leading cause of childhood paralysis), bowel and bladder control problems, learning disabilities, hydrocephalus, surgical procedures, latex allergies, increased health problems with age

Emotional CostsEmotional Costs:: Miscarriage, stillbirth, infant mortality (death before 1st birthday), disability, feeling “different”

The High Cost of NTDsThe High Cost of NTDs

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Factors Associated With Factors Associated With Increased Risk of NTDs. . .Increased Risk of NTDs. . .Factors Associated With Factors Associated With

Increased Risk of NTDs. . .Increased Risk of NTDs. . .

Family history of NTD A previous pregnancy

affected with NTD Maternal insulin-

dependent diabetes Maternal obesity Anti-epileptic drugs

(Valporic Acid/Kepakene, Carbamazapine)

Lower socioeconomic/educational level

Race/ethnicity Geography Exposure to high

temperatures in pregnancy

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What Are the Recommended What Are the Recommended Levels of Folic Acid?Levels of Folic Acid?

What Are the Recommended What Are the Recommended Levels of Folic Acid?Levels of Folic Acid?

U.S. Public Health Service recommendation:

“All women of childbearing age capable of becoming pregnant should consume 400 micrograms (or 0.4 milligrams) of folic acid daily.”

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CDC RecommendationCDC RecommendationCDC RecommendationCDC Recommendation

“All women of childbearing age in the United States

who are capable of becoming pregnant

should consume 400 mcg. of folic acid per day

for the purpose of reducing their risk

of having a pregnancy affected

with a Neural Tube Defect.

Women who have had prior NTD-affected pregnancy

are at risk of having a subsequent affected pregnancy.”

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Folic Acid For WomenFolic Acid For WomenFolic Acid For WomenFolic Acid For Women

All women of childbearing age should receive 400 micrograms (0.4 mg) of folic acid daily.

Women who have had a previous child with NTD should receive 4000 micrograms (4 mg) of folic acid daily.

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Folic Acid Awareness:Folic Acid Awareness:Survey of Missouri Women Age 18-44Survey of Missouri Women Age 18-44


47%

90%

0%

20%

40%

60%

80%

100%

Take Vitaminwith Folic Acid

Take daily

1999 Missouri BRFSS

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The survey highlights the following characteristics of

women in the survey who were less likely to take a daily

folic acid supplement.

Women aged 18-24 (37.1%) Annual income less than $15,000 (27.1%) Less than a High School diploma (19.2%) High School diploma (39.1%)

1999 Missouri BRFSS

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1999 Missouri BRFSS

0.00%

5.00%

10.00%15.00%

20.00%

25.00%

30.00%35.00%

40.00%

Ages 18-24 Incomeless than$15,000

Less than H.S.

diploma

H.S.diploma

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Blood Pressure

Birth DefectsOther

Strong Bones

Unknown

Reasons for Taking Folic AcidReasons for Taking Folic AcidReasons for Taking Folic AcidReasons for Taking Folic Acid

1999 Missouri BRFSS

3.7

36.9

25.8

19.1

14.5

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What Can You Do?What Can You Do?What Can You Do?What Can You Do?

Take a multivitamin with 400 mcg. of folic acid every day for your health.

Help spread the message about the need for folic acid for health and to reduce birth defects.

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Resource ListResource ListResource ListResource List Missouri Department of Health and Senior

Services, Division of Nutritional Health and Services, 573-522-9144

http://www.health.mo.gov/living/wellness/nutrition/nutritionpregnancy/index.php

Centers for Disease Control and Prevention www.cdc.gov/ncbdd/folicacid/index.html

March of Dimes 1-888-MODIMES www.modimes.com

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FOLIC ACID: For The Future