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The Top Nutrient for
Preventing Birth Defects

Author: be well™ with Big Y® Registered Dietitian Team

There are very few nutrients that can impact a child’s health as directly as folic acid or, its natural form, folate. Such remarkable impact it has on reducing the risk of birth defects, this B-vitamin became the driving force behind a national mandatory food fortification program in the United States in 1998. The result? The Centers for Disease Control and Prevention (CDC) cites, each year, folic acid fortification in foods helps prevent 1,300 cases of babies born with specific birth defects to the brain (anencephaly and encephalocele) and spine (spina bifida), collectively called neural tube defects.1

What Is Folic Acid?

Folic acid is the synthetic, or man-made, form of the vitamin folate. Folate is a water-soluble B-vitamin (B-9) found in an array of foods, including vegetables, fruits, dried beans, nuts and animal-based proteins. 

Why Is Folic Acid So Important?

Folate, or folic acid, is a key nutrient that aids in the replication of DNA (Deoxyribonucleic acid) and RNA (Ribonucleic acid) at the cellular level.2 Meaning, having enough folic acid circulating in a woman’s body is crucial for cell division to occur immediately upon conception of a child. Without an adequate amount of folic acid present, a newly fertilized egg may not divide properly.

In the case of neural tube defects, a lack of folic acid available during the first 3 to 4 weeks of gestation may prevent the proper development of a baby’s neural tube that eventually forms the brain and spinal column. When this occurs to the brain, as in the case of anencephaly, the risk of infant mortality upon birth is nearly guaranteed.3 If baby’s spinal column is impacted, a condition called spina bifida may occur. The physical and intellectual impacts of spina bifida can vary from one person to the next, so symptoms and treatments will range from mild to severe.4

Who Should Focus On Folic Acid Most?

Although folic acid is an essential nutrient for both men and women, when it comes to reducing the risk of birth defects, females are the key population of concern. This means any female of child-bearing age—teen, young adult or adult—needs to ensure they’re meeting daily folic acid recommendations. Why? Because 35% of pregnancies remain unintended.5 And since most pregnancies are not realized until around 5 ½ weeks gestation,6 beginning to supplement with folic acid at that time may be too late for preventing neural tube defects.

How Much Folic Acid Should You Get?

Women are recommended to obtain 400 micrograms folic acid each day, as soon as they are able to bear children (meaning: when puberty begins). Once women become pregnant, their folic acid needs jump to 600 micrograms each day. While nursing, mom’s needs remain elevated at 500 micrograms each day.2

Sources of Folic Acid

Folic acid can be found in supplements, either alone or in conjunction with other nutrients in a basic multivitamin with minerals, as well as fortified to certain foods.

Daily Supplements

When shopping for a supplement, you may see the abbreviation DFE in the unit of measure for folic acid listed on the label. DFE stands for dietary folate equivalent and was developed since the bioavailability of folate found in food, or the amount typically absorbed by the body, is around 50% versus 85% when folic acid is ingested with food.2 For example, a supplement may have 665 mcg DFE (400 mcg folic acid) listed on its label.

Enriched Foods

With the launch of the mandatory folic acid fortification program in 1998, folic acid began being fortified to certain cereal grain-foods. To find grains fortified with folic acid, look for the words “fortified” (e.g.: ready-to-eat cereals and corn masa) or “enriched” (e.g.: enriched bread, flour, rice, pasta and cornmeal) on packaging and check the Nutrition Facts Label to find the amount of folic acid offered per serving.7

Natural Sources Of Folate

As mentioned above, folate can be found in an array of foods such as vegetables, fruits, dried beans, nuts and animal-based protein foods. Ensure you eat a variety of foods, including forms of foods (e.g.: fresh, frozen, dried, canned and 100% juice), to not only meet overall nutrition goals but also daily folic acid needs.

Not an exhaustive listing by any means, here is a short list of folate-containing foods:

✓  Spinach
✓  Asparagus
✓  Avocado
✓  Frozen broccoli
✓  Kidney beans
✓  Orange juice
✓  Peanuts
✓  Banana
✓  Hard-boiled eggs

Can You Meet Daily Folic Acid Recommendations by Food Alone?

Although the mandatory fortification program has done much to close the gap on folic acid intake in the United States, researchers observe the average intake of folic acid remains to be 190 micrograms each day.8 This is why supplementing with folic acid, while you incorporate folic acid-fortified and folate-containing foods into your meal plan, is recommended.9

Additionally, not all grains are fortified or enriched with folic acid. For example, whole grains are not typically enriched with folic acid. Therefore, if you are working toward meeting daily whole grain and fiber goals by eating whole grain foods such as whole wheat bread, whole grain pasta and brown rice, you will more than likely not consume a folic acid fortified or enriched grain. Therefore, supplementing with folic acid is the most direct route to meet folic acid and daily whole grain and fiber recommendations—all important nutrients for a pregnant woman and growing baby.

1  Centers for Disease Control and Prevention (CDC). Updated estimates of neural tube defects prevented by mandatory folic acid fortification — United States, 1995–2011. MMWR Morb Mort Wkly Rep. 2015;64(01):1-5. https://www.cdc.gov/ncbddd/folicacid/features/folicacid-prevents-ntds.html.
2  National Institutes of Health (NIH) Office of Dietary Supplements (ODS). Fact sheet for health professionals on folate. Accessed on 1/2/2024. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/.
3  National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Facts about anencephaly. Accessed 1/2/2024. https://www.cdc.gov/ncbddd/birthdefects/anencephaly.html.
4  National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. What is spina bifida? Accessed 1/2/2024. https://www.cdc.gov/ncbddd/spinabifida/facts.html.
5  Rossen LM, Hamilton BE, Abma JC, et al. Updated methodology to estimate overall and unintended pregnancy rates in the United States. National Center for Health Statistics. Vital Health Stat. 2023;2(201). https://dx.doi.org/10.15620/cdc:124395.
6  Branum, AM, Ahrens, KA. Trends in Timing of Pregnancy Awareness Among US Women. Matern Child Health J. 2017;21:715–726. https://doi.org/10.1007/s10995-016-2155-1.
7  United States Food and Drug Administration. Folate and folic acid on the nutrition and supplement facts labels. Accessed 1/3/2024. https://www.fda.gov/food/nutrition-facts-label/folate-and-folic-acid-nutrition-and-supplement-facts-labels#:~:text=Foods%20that%20are%20fortified%20with,found%20in%20certain%20dietary%20supplements.
8  Choumenkovitch SF, Selhub J, Wilson PW, et al. Folic acid intake from fortification in United States exceeds predictions. J Nutr. 2002;132:2792-8. https://doi.org/10.1093/jn/132.9.2792.
9  National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Folic acid recommendations. Accessed 1/3/2024. https://www.cdc.gov/ncbddd/folicacid/recommendations.html.

Published 1/29/2024