Neural tube defects are the second most common serious fetal malformations in
the United States, surpassed only by congenital heart disease. Each year in this country, they affect approximately
4,000 pregnancies for a frequency of 2 to 4 per 1,000 live births. Of the survivors, The Centers for Disease Control
has estimated that the lifetime cost of care per individual approaches $300,000.
The term neural tube defect covers a large spectrum of central nervous system malformations ranging from small defects
in the cranium (skull) and vertebrae (backbones) to total absence of closure of the neural tube itself. This is
a serious problem in which one-third of the affected newborns will die and of the survivors, sixty-five percent
will have serious handicaps. In general there is not felt to be one specific cause for neural tube defects. Rather,
there are likely several factors that when combined create a situation to put a fetus at risk. Some of these factors
involve genetics and other factors are related to environmental issues.
Since 1991 we have known that at least fifty percent of the cases of neural tube
defects could be prevented by women using folic acid supplements daily before becoming pregnant. Folic acid is
a B vitamin that is needed for the production of certain amino acids which are deficient in cases of neural tube
defects. In September of 1992, The Public Health Service published their recommendations that 400 micrograms of
folic acid (also called "folate") should be consumed daily by all women of childbearing age. In addition,
they recommended that women with a history of a previously affected child should consume 4 milligrams daily (or
ten times the regular dose) for at least three months prior to conceiving and then throughout the first thirteen
weeks of pregnancy.
This information is so important that recently The Food and Drug Administration
has required that by January of 1998 foods such as breads, cereals, and rice be enriched with folic acid. However,
even this effort would only increase the average daily consumption by 100 micrograms or just one-fourth of the
needed daily requirement.
In 1995, two studies were done to determine if this important message was getting
out, and unfortunately it was not. In one of these studies, the Gallop Organization conducted a poll for The March
of Dimes Foundation. This survey included over 2,000 women of reproductive age. Overall, only half of the women
had reported ever hearing of or reading about folic acid. And of those, only nine percent knew that it helped prevent
birth defects while only six percent knew specifically that it reduced the risk of spina bifida. Even more concerning,
was that of women who had become pregnant recently, only twenty percent had been using the supplement prior to
their pregnancy. In a separate study, The Georgia Department of Human Resources obtained similar results. The message
here is that over eighty percent of the 60 million women in this country of reproductive age may not be obtaining
the recommended amount of folic acid needed to prevent these birth defects.
The take home message should be: if you are a woman between the ages of 18 and
45 who is planning to become pregnant, you should be using a vitamin supplement that contains at least 400 micrograms
(or 0.4 mg) of folic acid. This can be found in most vitamins made for women or in prenatal vitamins. If you are
unsure about whether the supplement that you are using is sufficient, discuss it with your physician.
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