The B vitamin folic acid has been identified as helping to prevent neural tube defects (NTDs). The neural tube begins to form the baby's brain and spine two to three days after the missed menstrual period and is completely formed within approximately 10 days (27 days after conception). If the neural tube fails to close, two devastating birth defects can occur. Anencephaly, absence or deficiency of a major portion of the cranial vault (skull), results in stillbirth or death shortly after birth. Spina bifida, a visible sack or epithelial defect (opening in the spine), causes varying degrees of disability related to paralysis, lack of bowel and bladder control and hydrocephalus. With the help of medical care, babies born with spina bifida reach adulthood. The lifetime costs associated with a single case of spina bifida, which includes medical, special education, therapy services, and loss of earnings, are estimated to be as high as $1 million.
In 1992, the Centers for Disease Control and Prevention (CDC) of the Untied States Public Health Service (USPHS) issued a recommendation that all women capable of becoming pregnant consume 400 micrograms (0.4 milligrams) of folic acid each day to reduce their risk of having a pregnancy affected by an NTD. The daily consumption throughout childbearing years is critical, because the developing baby needs the folic acid before the mother would recognize the pregnancy. Since half of all women do not plan their pregnancies, daily intake of a multivitamin containing folic acid is crucial for prevention. Folic acid occurs naturally in foods as folate (polyglutamate form). Consuming foods high in folate would appear to be the best way to meet the PHS recommendation. Unfortunately, folate is not contained in a wide variety of food, only half of all food folate is able to be absorbed and 50 to 90 percent of naturally occurring food folate is destroyed in cooking. Beginning January 1998, cereal grains began being fortified with folic acid. However, the level of fortification required does not add enough folic acid to the diet to reach the recommended amount. The prudent message for all women capable of becoming pregnant is to take a multivitamin containing 400 mcg. (0.4 mg.) of folic acid each day, consume foods fortified with folic acid and eat a variety of foods. USPHS recommendation.
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Preventing the Recurrence of Neural Tube Defects
Women who have had a previous pregnancy affected by an NTD are greater risk of having another pregnancy affected by an NTD. In 1991, the CDC of the USPHS issued a recommendation for women who have had a previous pregnancy affected by an NTD to consume 400 micrograms (0.4 milligrams) of folic acid every day throughout their childbearing years. When planning future pregnancies, women should be aware that one-month before conception and for the first three months of pregnancy, they need to increase the amount of folic acid ten-fold, to 4.0 milligrams each day. This level can only be obtained through a doctor's prescription. USPHS recurrence recommendation.
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