FREE ESSAY ON HOW FOLATE CAN HELP PREVENT BIRTH DEFECTS

HOW FOLATE CAN HELP PREVENT BIRTH DEFECTS

How Folate Can Help Prevent Birth Defects
If you plan to have children some day, here's important information for the future
mother-to-be: Think folate now. 
Folate is a B vitamin found in a variety of foods and added to many vitamin and mineral
supplements as folic acid, a synthetic form of folate. Folate is needed both before and
in the first weeks of pregnancy and can help reduce the risk of certain serious and
common birth defects called neural tube defects, which affect the brain and spinal cord.

The tricky part is that neural tube defects can occur in an embryo before a woman
realizes she's pregnant. That's why it's important for all women of childbearing age (15
to 45) to include folate in their diets: If they get pregnant, it reduces the chance of
the baby having a birth defect of the brain or spinal cord. 
Adequate folate should be eaten daily and throughout the childbearing years, said
Elizabeth Yetley, Ph.D., a registered dietitian and director of FDA's Office of Special
Nutritionals. 
Folate's potential to reduce the risk of neural tube defects is so important that the
Food and Drug Administration requires food manufacturers to fortify enriched grain
products with folic acid. This will give women one way to get sufficient folate: by
eating fortified breads and other grain products, such as enriched pasta, rice, waffles
and cereal bars. 
Other ways to do this are: 
-  Eat fruits, dark-green leafy vegetables, dried beans and peas, and other foods that
are natural sources of folate. 
-  Eat folic acid-fortified enriched cereal grain products and breakfast cereals. 
-  Take a vitamin supplement containing folic acid.
Nutrition information on food and dietary supplement labels can help women determine
whether they are getting enough folate, which is 400 micrograms (0.4 milligrams) a day
before pregnancy and 800 micrograms a day during pregnancy. 
Neural Tube Birth Defects 
The technical names of the two major neural tube birth defects reduced by adequate folate
intake are anencephaly and spina bifida. Babies with anencephaly do not develop a brain
and are stillborn or die shortly after birth. Those with spina bifida have a defect of
the spinal column that can result in varying degrees of handicap, from mild and hardly
noticeable cases of scoliosis (a sideways bending of the spine) to paralysis and bladder
or bowel incontinence. With proper medical treatment, most babies born with spina bifida
can survive to adulthood. But they may require leg braces, crutches, and other devices to
help them walk, and they may have learning disabilities. About 30 percent have slight to
severe mental retardation. 
The national Centers for Disease Control and Prevention estimate that about 2,500 infants
with spina bifida and anencephaly are born each year in the United States. 
Other maternal factors also may contribute to the development of neural tube defects.
These include: 
-  family history of neural tube defects 
-  prior neural tube defect-affected pregnancy 
-  use of certain antiseizure medications 
-  severe overweight 
-  hot tub use in early pregnancy 
-  fever during early pregnancy 
-  diabetes.
Any woman concerned about these factors should consult her doctor. 
Folate Link 
Scientists first suggested a link between neural tube birth defects and diet in the
1950s. The incidence of these conditions has always been higher in low socioeconomic
groups in which women may have poorer diets. Also, babies conceived in the winter and
early spring are more likely to be born with spina bifida, perhaps because the mother's
diet lacks fresh fruits and vegetables--which are good sources of folate--during the
early weeks of pregnancy. 
In 1991, British researchers found that 72 percent of women who had one pregnancy with a
neural tube birth defect had a lower risk of having another child with this birth defect
when they took prescription doses of folic acid before and during early pregnancy. 
Another study looked at folic acid intake in Hungarian women. The evidence indicated that
mothers who had never given birth to babies with neural tube defects and who took a
multivitamin and mineral supplement with folic acid had less risk in subsequent
pregnancies for having babies with neural tube defects than women given a placebo. 
These studies led the U.S. Public Health Service in September 1992 to recommend that all
women of childbearing age capable of becoming pregnant consume 0.4 mg of folate daily to
reduce their risk of having a pregnancy affected with spina bifida or other neural tube
defects. 
That corresponds to FDA's Daily Value for folic acid, which is 400 micrograms for
nonpregnant women, as well as children 4 and older and adult men. For pregnant women, the
Daily Value jumps to 800 micrograms. Daily Values are dietary reference numbers used on
the Nutrition Facts panel on food labels to show the amounts of various nutrients in a
serving of food. 
Many women between 19 and 50 consume much less than 400 micrograms of folate a day,
according to the U.S. Department of Agriculture. 
Folate Sources 
Folate occurs naturally in a variety of foods, including liver; dark-green leafy
vegetables such as collards, turnip greens, and Romaine lettuce; broccoli and asparagus;
citrus fruits and juices; whole-grain products; wheat germ; and dried beans and peas,
such as pinto, navy and lima beans, and chickpeas and black-eyed peas. 
Under FDA's folic acid fortification program, which became effective January 1998, the
agency requires manufacturers to add from 0.43 mg to 1.4 mg of folic acid per pound of
product to enriched flour, bread, rolls and buns, farina, corn grits, cornmeal, rice, and
noodle products. A serving of each product will provide about 10 percent of the Daily
Value for folic acid. Whole-grain products do not have to be enriched because they
contain natural folate. Some of the natural folate in non-whole-grain products is lost in
the process of refining whole grains. 
Folate also can be obtained from dietary supplements, such as folic acid tablets and
multivitamins with folic acid, and from fortified breakfast cereals. 
A report recently released by the Institute of Medicine indicates that the evidence
suggests that folic acid, the synthetic form of folate, may be better absorbed than
folate found naturally in foods. The report also points out that, if taken in adequate
amounts, food folate may eventually be demonstrated to be as effective as folic acid. 
Finding Foods with Folate 
Certain information on food and dietary supplement labels can help women spot foods
containing substantial amounts of folate. Some labels may claim that the product is high
in folate or folic acid, which means a serving of the food provides 20 percent or more of
the Daily Value for folic acid. Or the label may say the food is a good source of folate,
which means a serving of the food provides 10 to 19 percent of the Daily Value for folic
acid. The exact amount will be given in the label's Nutrition Facts panel. 
Some food and dietary supplement labels may carry a longer claim that says adequate
folate intake may reduce the risk of neural tube birth defects. Products carrying this
claim must: 
-  provide 10 percent or more of the Daily Value for folic acid per serving 
-  not contain more than 100 percent of the Daily Value for vitamins A and D per serving
because high intakes of these vitamins are associated with other birth defects 
-  carry a caution on the label about excess folic acid intake, if a serving of food
provides more than 100 percent of the Daily Value for folic acid. FDA has set 1 mg (or
1,000 micrograms) of folate daily as the maximum safe level. There are limited data on
the safety of consuming more than 1 mg daily, and there may be a risk for people with low
amounts of vitamin B12 in their bodies--for example, older people with malabsorption
problems, and people on certain anticancer drugs or drugs for epilepsy whose
effectiveness can diminish when taken with high intakes of folate. 
-  list on the label's Nutrition or Supplement Facts panel the amount by weight in
micrograms and the %Daily Value of folate per serving of the product. This information,
which appears toward the bottom of the panel, along with the listing of other vitamins
and minerals, can be used to compare folate levels in various foods and supplements.
Optional information may appear with the health claim to let consumers know about other
risks associated with neural tube birth defects, when to consult a doctor, other foods
that are good sources of folate, and other important messages about neural tube defects.

Other Considerations 
The claim about folate cannot imply that adequate folate intake alone will ensure a
healthy baby, since so many factors can affect a pregnancy. 
Women should bear this in mind when contemplating pregnancy, advises Jeanne Latham, a
registered dietitian and consumer safety officer in FDA's Office of Special Nutritionals.
Folate can make a significant contribution, she said, many factors, including an overall
good diet, are involved in having a healthy baby. 
Genetics plays a role, as do other healthful prenatal practices, such as eating an
all-around good diet. But unlike genetics, diet is a risk factor women can modify to
their--and their baby's--advantage, said Jeanne Rader, Ph.D., director of the division of
science and applied technology in FDA's Office of Food Labeling. 
Folic acid is one of many nutrients needed in a healthy diet for women of childbearing
age, she said. A well-balanced diet with a variety of foods can provide all those
nutrients, including adequate amounts of folate. 
Women have options for reaching the folate intake goal: They can get the necessary
nutrients and calories both before and during pregnancy by eating a well-balanced diet,
keeping in mind folate-rich foods, nutrition experts say. Folic acid-fortified grain
products, including breakfast cereals, will help, too. Dietary supplements are another
source of folate. Any one or a combination of these options for ensuring adequate folate
can help assure women of childbearing age that, if they become pregnant, their babies
will be off to a healthy start.