Birth Defects Prevention: Realizing the Full Potential of Folic Acid

Post-program Discussion Forum

An online discussion forum was conducted for this program. Participants were invited to ask questions and share their best practices. View the archived discussion forum below.

 

Subject: Welcome!
Posted by: Alina L. Flores on 09/30/05

Welcome to the discussion forum for the grand rounds session Birth Defects Prevention: Realizing the Full Potential of Folic Acid! The forum will be available until October 7th, 2005. I invite you to submit your ideas, questions, and comments and encourage ongoing discussion of the important issues related to folic acid and birth defects prevention.

Subject: Florida Resources
Posted by: Kimberlea Hauser on 09/30/05
In Reply to: Welcome! posted by Alina L. Flores on 09/30/05:

Please visit the Florida Folic Acid Coalition website at www.folicacidnow.net. In addtion, through the March of Dimes Florida Chapter Vita Grant, the Florida Depeartment of Health is providing free multivitamins to under served women of child bearing age. The Vita Grant will provide free multivitmaims through 2007.

The University of South Florida through March of Dimes funding has developed a series of materials targeted at Hispanic women. The materials include a low-literacy brochure, a photo novella (The Story of Three Sisters), and a video novella based on the photo novella.

The University of Florida, also with March of Dimes funding, developed the " Folic Acid Every Day" tool-kit. Another of UF's folic acid products includes a program targeted at youth and distributed through the 4-H program in Florida.

Please feel free to contact me or other members of the Florida Folic Acid Coaltion regarding our programs and materials. Our contact information is on our website.

Kim

 

Subject: Prevalence and Causes
Posted by: Byron Breedlove on 09/30/05

Interesting rounds but I wonder about a few things. First, quite a bit of research I have read notes the high incidence of spina bifda and NTDs amongs persons of Irish descent, which was not mentioned today. Second,if folic acids works about half the time (50%-70% effective) to reduce NTDs, what, then, might be causing the other half of the NTDs?

Subject: Re: Prevalence and Causes
Posted by: Alina L. Flores on 09/30/05
In Reply to: Prevalence and Causes posted by Byron Breedlove on 09/30/05:

Hi Byron. Good question. The latest research has shown that rates of NTDs are highest among Hispanic women. This is a change from the trend seen years earlier, that pointed to women of Irish descent as those having the higher rates. Spina bifida was indeed once considered a " blue eye, blond hair" condition, owing to the higer rates among women of Irish descent. However, research now shows that these rates have shifted with Hispanic women having the higher rates.

You are correct. Up to 70% of NTDs are considered folic acid preventable. The remaining percentage may be due to a combination of genetic and environmental factors. More research into this area is needed.

 

Subject: Folate consumption among Hispanics
Posted by: Wes Duke, MD MPH on 09/30/05

The comment was made regarding the increased risk of NTD's among Hispanic women, with one explanation being inadequate dietary intake of fortified grains/cereals. The graph showing pre and post fortification rates of NTD's by race/ethnicity seemed to show that the most dramatic decrease in pre- and post- rates was in fact among Hispanics, eventhough their rates over all were higher for pre and post-. This seems contradicatory and if in fact they do not have adequate intake of fortified grains, then I would not have expected such a steep drop relative to other ethnicities/race?

Subject: Re: Folate consumption among Hispanics
Posted by: Alina L. Flores on 09/30/05
In Reply to: Folate consumption among Hispanics posted by Wes Duke, MD MPH on 09/30/05:


Hi Wes. Thank you for your question, it's a good one. Inadequate dietary intake of fortified foods really can't be looked at in isolation as a cause of higher NTD rates among Hispanic women. There are several factors, including inadequate dietary intake of fortified foods along with lower levels of multivitamin and synthetic folic acid consumption, that really need to be looked at in combination. We understand that there are probably other factors that have not yet been well documented that may also play a role into why we saw such a steep drop in rates among Hispanic women. We certainly would hope that intensive education efforts put forth by several states have helped to increase fortified food intake and multivitamin consumption among Hispanic women.

 

Subject: folic acid intake via vitamin and alcohol consumption
Posted by: Andrea Meagher on 10/03/05


does alcohol deplete folic acid in the body (if one is taking a supplement)? if so, is there a dose dependent effect? for example, if one drinks 1 glass of red wine per day (no effect) vs. 3 glasses per day (measured depletion)?

I understand that 400 mcg is the recommended dose, however what is the min dose that shows reduction...for example 200 mcg shows 20% incidence reduction?

Subject: Re: folic acid intake via vitamin and alcohol consumption
Posted by: Katie Kilker on 10/05/05
In Reply to: folic acid intake via vitamin and alcohol consumption posted by Andrea Meagher on 10/03/05:

Andrea,
Alcohol can decrease folic acid absorption. Folic acid is a water-soluable vitamin, which means that what the body doesn't use it excretes, so folic acid needs to be replenished every day. If a woman drinks alcohol, her body may not be absorbing all of the folic acid she consumes each day. We are not aware of any data about the relationship between alcohol dosage and absorption.

However, another thing to think about is that if a woman is planning to become pregnant or could possibly become pregnant, she should avoid alcohol consumption altogether. Drinking any amount or kind of alcoholic beverage during pregnancy-including during the first few weeks, before she knows she is pregnant- can put a baby at risk for a lifetime of problems associated with a fetal alcohol spectrum disorder.

About your next question...
CDC and the US Public Health Service recommends a daily dose of 400 mcg of folic acid daily for all women of childbearing age. This dose, 400 mcg, was the smallest dose that the US Public Health Service could recommend for the prevention of neural tube defects. Smaller daily doses of folic acid may have protective benefits of a lesser degree but it is not proven. We have seen a partial decline in affected pregnancies as a result of fortification of flour with folic acid. This may suggest that lower dosages of folic acid could prevent some cases. At this point in time, the recommendation reamins at 400 mcg daily.

If you have additional questions about neural tube defects or folic acid, please email the team at flo@cdc.gov.

 

Subject: Please submit a question or comment by 10/07/2005
Posted by: Katie Kilker on 10/05/05

Thank you all so much for your participation in this important broadcast! If you have questions or comments, please post them here before 10/07/05.
After 10/07/05, you may email a question or comment to the Birth Defects Prevention Research Team at CDC at flo@cdc.gov.
You can find more information about folic acid and birth defects prevention online at: www.cdc.gov/folicacid
You can order free folic acid educational materials online at: http://www2.cdc.gov/ncbddd/faorder

Thank you!
Katie Kilker
Birth Defects Prevention Research Team
CDC/NCBDDD

 

Subject: Folic Acid Fortification Of Corn Flour
Posted by: Ellen Finegan R.N. B.S.N. on 10/06/05

How can the public health professionals partner with other organizations to work toward the fortification of corn flour with folic acid ? Cindy Brownstein mentioned her work with the C.D.C. and the Spina Bifida Association to encourage the company that makes MASECA corn flour to consider voluntary fortification.

Subject: Re: Folic Acid Fortification Of Corn Flour
Posted by: Alina L. Flores on 10/07/05
In Reply to: Folic Acid Fortification Of Corn Flour posted by Ellen Finegan R.N. B.S.N. on 10/06/05:

Hello Ellen,
The National Council on Folic Acid (NCFA) is leading efforts to approach GRUMA, a major cornmeal manufacturer, about the possibilities of folic acid fortification of its products at the recommended levels. Organizations can participate by signing letters going out to GRUMA or can write letters to GRUMA themselves. It would be best for interested organizations to contact NCFA for more information. The website is http://www.folicacidinfo.org and the contact email is info@folicacidinfo.org Thank you for your interest in this important issue!