CDC’s Work to Understand and Prevent Neural Tube Defects (NTDs)

Taking folic acid before and during pregnancy can help reduce neural tube defects (NTDs), which are major birth defects of a baby’s brain and spine (including anencephaly and spina bifida), by up to 70%.

The Centers for Disease Control and Prevention (CDC) monitors NTDs, conducts research in why they occur and how to prevent them, and develops programs to prevent them from occurring.

Prevention Programs and Evaluation

CDC promotes the use of folic acid among all women who can get pregnant by creating, testing, and sharing free, easy-to-read, and useful educational materials in English and Spanish and other tools. CDC leads efforts to identify and disseminate effective messages for those planning a pregnancy and those not planning a pregnancy. CDC also promotes folic acid use by developing effective educational programs that target women who appear to have a greater chance of having a baby born with an NTD. For example, CDC is evaluating whether using promotoras (lay health outreach workers) is effective in communicating to Latinas that taking folic acid before and during pregnancy can help prevent NTDs.

Pregnant woman holding her belly

Birth Defects COUNT

Birth Defects COUNT, a CDC global initiative to prevent neural tube defects, provides the scientific and programmatic expertise to build upon and strengthen global neural tube defects surveillance and expand the reach of global folic acid fortification. Learn more about Birth Defects COUNT.

Birth Defects COUNT


CDC works with state birth defects programs to track the number of babies with spina bifida and other birth defects in the United States and reports these numbers annually. This way, we can find out if the number is rising, dropping, or staying the same. We can also evaluate the prevalence according to where people live and by other factors. This information can help us evaluate the effectiveness of folic acid promotion efforts, and conduct research related to identifying risk factors for birth defects. It can also lead to opportunities for additional prevention.


National Birth Defects Prevention Study (NBDPS)

NBDPS is the largest population-based U.S. study looking at risk factors for and potential causes of birth defects. Current folic acid research activities of the NBDPS include assessing:

  • How a woman’s intake of nutrients, including folic acid, could affect the risk for specific birth defects.
  • Why Hispanics have higher rates of NTDs.
  • Women’s behaviors related to preventing birth defects, including folic acid use and alcohol use.
National Health and Nutrition Examination Survey (NHANES)

NHANES is an annual survey designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. CDC uses information from NHANES to look at how much folic acid people are getting from the foods they eat and dietary supplements or vitamins they take. The survey also provides information on the actual levels of folate circulating in the blood. We look at both folic acid intake and blood folate levels among many individuals including pregnant women, non-pregnant women of childbearing age, adults, children, and people with certain conditions, such as diabetes or obesity.

Behavioral Risk Factor Surveillance Survey (BRFSS)

The BRFSS is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States annually since 1984. CDC uses information from BRFSS to assess levels of folic acid supplement use among women who may become pregnant, and other health behaviors related to having a healthy pregnancy.

Did You Know?

  • In the United States, there are 3,000 pregnancies affected by spina bifida or anencephaly each year.
  • Hispanic/Latina women have a higher rate of NTD-affected pregnancies than non-Hispanic white and non-Hispanic black women.
  • The total lifetime cost of care for a child born with spina bifida is estimated to be $791,900.
Pregnancy Risk Assessment Monitoring System (PRAMS)

PRAMS is a surveillance project of CDC and state health departments. PRAMS collects state-specific data on maternal attitudes and experiences before, during, and shortly after pregnancy.