TUESDAY, June 4, 2002 (HealthDayNews) -- The importance of folic acid in reducing birth defects is well-known to doctors, but when it comes to those to whom it matters the most -- women of childbearing age -- awareness is still woefully low.
A new survey from the March of Dimes highlights the problem, indicating that 70 percent of American women of childbearing age fail to take the vitamin daily, and only 20 percent are even aware that folic acid prevents birth defects.
Even fewer, just 10 percent, report being aware of the most important condition of folic acid's role in preventing birth defects -- that it must be taken in the months before becoming pregnant, in addition to the early part of the pregnancy, to be fully beneficial.
The telephone survey of 2,004 women between the ages of 18 and 45 was the sixth annual survey of its kind. It was conducted earlier this year by the Gallup organization for the March of Dimes.
Specifically, folic acid, a B vitamin, has been strongly linked with preventing serious birth defects of the brain and spine called neural tube defects (NTDs), which affect an estimated 2,500 infants in the United States each year, according to the March of Dimes.
The most common NTD is spina bifida, which affects the backbone and is a leading cause of childhood paralysis. Another NTD is anencephaly, a fatal condition in which an infant is born with a severely underdeveloped brain and skull.
NTDs can also cause pregnancies to end in miscarriage or stillbirth.
Since NTDs begin in the earliest stages of pregnancy, it's important to already have a buildup of folic acid in your system to prevent defects.
According to Dr. Siobhan Dolan, an associate professor of obstetrics and gynecology at Albert Einstein College of Medicine and spokesman for the March of Dimes, the apparent lack of awareness of folic acid's benefits may simply be a result of the information overload concerning pregnancy.
"There's so much information out there concerning pregnancy these days, sometimes it's hard to sort out what's the fad and what's actually scientifically proven," she says.
Folic acid's benefits certainly fall into the latter category, having been so effective in preventing recurring NTDs in a study of women who'd already had a one NTD pregnancy that the study was halted before completion, Dolan says.
"They stopped the study early because it was considered unethical to deprive the control group of the benefits that were so obviously seen in the women receiving folic acid," she says. "There's really compelling evidence."
In the general population, the March of Dimes estimates the widespread use of folic acid by most women in childbearing years could reduce NTDs by up to 70 percent.
While there's no question that folic acid indeed helps prevent defects, it's not known precisely how it does so. The March of Dimes suspects the vitamin in supplement form may work to either correct a flaw in the way that some people's bodies process folates (the natural form of folic acid in food), or it may work to otherwise correct a nutritional deficiency.
In response to the evidence of its benefits, however, the U.S. Public Health Service recommended in 1992 that all women who are capable of becoming pregnant consume 400 micrograms of the folic acid per day to reduce their risk of having a pregnancy affected by NTDs. Women with higher risk factors, such as having had a previous NTD, are recommended to take higher amounts.
The March of Dimes' survey indicates that knowledge of that recommendation has increased from just 15 percent in 1995 to 37 percent this year.
Interestingly, however, respondents suggest the advice might be taken much more seriously if heard from women's own health-care providers. Among those who reported not taking folic acid, 53 percent said they would be "very likely" to take it if directly recommended by their physician or health-care provider, and another 37 percent said they would be "somewhat likely" to take the advice.
Dr. Luis Curet, a professor of obstetrics and gynecology at the University of New Mexico, says that too often, women will have heard about folic acid's benefits in preventing birth defects, and simply assume it should therefore be taken only during pregnancy.
"It really is so important that it be started before the women gets pregnant -- by the time a woman gets to prenatal care, it's almost too late," he explains. "That doesn't mean they can't get other benefits and shouldn't take it at that point, but in terms of the prevention of NTDs, women really need to take it earlier."
Experts recommend that women try to get as much folic acid, or folate, as they can from dietary sources such as citrus fruits, leafy greens, peanuts, broccoli and legumes.
However, it's known the body more readily absorbs folic acid from vitamin supplements or food that has been fortified with synthetic folic acid, such as flour, rice, pasta and other grain products.
To be safe, Curet says, women should just count on supplements: "All women in the reproductive age should really just be on folic acid so that when they get pregnant they will already be prepared."
Despite the relatively low awareness of folic acid's benefits regarding birth defects, there is some encouraging news: the American Medical Association last year reported that NTDs in newborns had decreased 19 percent from 1995 to 1999, according to the March of Dimes.
What To Do
Visit the March of Dimes site on folic acid for much more information on how the vitamin prevents birth defects.
The American College of Obstetrics and Gynecology's patient education site offers links to numerous pamphlets on pregnancy and folic acid.
