Folic

1. This presentation was developed by the Missouri Department of Health and Senior
Services through a grant from the Centers For Disease Control and Prevention
FOLIC ACID:
For The Future
Missouri Department of Health and
Senior Services

2. 2
Course 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?

3. 3
What Is Folic Acid?
Folic acid is the synthetic form of a water
soluble B vitamin that is needed to:
 Make new cells/cell division
 Make normal-shaped red blood cells
 Help prevent anemia
 Help prevent birth defects
 Help prevent heart disease, stroke and
certain cancers.

4. 4
How Do You Get Folic Acid?

5. 5
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

6. 6
Fortified 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:

7. 7
Easiest Way!
Take a multi-
vitamin with
400 mcg. of
synthetic folic
acid every day

8. 8
Who Needs Folic Acid?
 All women aged
14-50 who COULD
become pregnant
 Pregnant women
 Everyone,
including men

9. 9
How Do NTDs Occur?
 Baby’s brain and spine fail to close completely
Neural tube closing properly to
form spinal column and brain.

10. 10
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.

11. 11
Anencephaly
 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

12. 12
Encephalocele
 Defect of the skull – smaller defect than
anencephaly
 Protrusion of brain or skin-covered brain
 Rarer than the other types of NTDs
 Overall mortality rate about 29%

13. 13
Spina Bifida
 Neural tube fails to close
properly:
• Occurs by 28 gestational
days
 Associated problems:
• Hydrocephalus
• Clubfoot
• Vertebral anomalies
• Renal anomalies
 Requires surgery 24-48
hours after birth

14. 14
Financial 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 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 Costs: Miscarriage, stillbirth,
infant mortality (death before 1st birthday),
disability, feeling “different”
The High Cost of NTDs

15. 15
Factors Associated With
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

16. 16
What Are the Recommended
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.”

17. 17
CDC 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.”

18. 18
Folic 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.

19. 19
Folic Acid Awareness:
Survey of Missouri Women Age 18-44
47%
90%
0%
20%
40%
60%
80%
100%
Take Vitamin
with Folic Acid
Take daily
1999 Missouri BRFSS

20. 20
Folic Acid Awareness:
Survey of Missouri Women Age 18-44
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

21. 21
Folic Acid Awareness:
Survey of Missouri Women Age 18-44
1999 Missouri BRFSS
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Ages 18-24 Income
less than
$15,000
Less than
H.S.
diploma
H.S.
diploma

22. 22
Blood Pressure
Birth Defects
Other
Strong Bones
Unknown
Reasons for Taking Folic Acid
1999 Missouri BRFSS
3.7
36.9
25.8
19.1
14.5

23. 23
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.

24. 24
Resource 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/nu
tritionpregnancy/index.php
 Centers for Disease Control and Prevention
www.cdc.gov/ncbdd/folicacid/index.html
 March of Dimes 1-888-MODIMES
www.modimes.com