CDC’s Articles on U.S. Folic Acid Intake, Fortification, and Neural Tube Defects

Key Findings

Key Findings: Daily Multivitamin Use among Women of Reproductive Age Declines
The Journal of Women’s Health published a study that examined the daily multivitamin use among women of reproductive age.
(Published: January 2019)

Key Findings: Are Women Getting Enough Folic Acid?
The American Journal of Clinical Nutrition published a study that shows that some U.S. women are still not getting enough folic acid in their diets to lower the risk of a neural tube defect.
(Published: May 2018)

Key Findings: Improving Healthcare Counseling among Hispanic Women before They Become Pregnant
The Journal of Women’s Health published a study that looked at healthcare counseling among Hispanic women on taking folic acid before and during pregnancy and medicine use during pregnancy.
(Published: March 2018)

Key Findings: The Promotora de Salud Model Promotes Positive Health Behavior Change
The Journal of Women’s Health has published a study examining the use of the Promotora de Salud model for folic acid education in Hispanic communities.
(Published: February 2017)

Key Findings: Cost Savings of Spina Bifida Prevention after Folic Acid Fortification in the United States
The American Journal of Preventive Medicine published a study looking at the costs associated with a United States requirement that folic acid (a B vitamin) be added to all cereal grain products labeled as enriched (also called folic acid fortification).
(Published: May 2016)

Key Findings: Blood Folate Concentrations and Risk of Neural Tube Defect-Affected Pregnancies: Where Does the United States Stand?
Birth Defects Research Part A published a study that looked at the amount of folate in the blood (blood folate concentrations) among women in the United States in relation to their risk of having a baby affected by a neural tube defect.
(Published: June 2015)

Key Findings: Folic Acid Fortification
CDC’s Morbidity and Mortality Weekly Report published a study that shows folic acid fortification in the United States continues to prevent neural tube defects.
(Published: January 2015)

Key Findings: Folic Acid Use among Pregnant Women Who Have Had a Past Pregnancy Affected by a Neural Tube Defect
CDC’s Morbidity and Mortality Weekly Report published a study looking at folic acid use before pregnancy in women who have had a previous pregnancy affected by a neural tube defect.
(Published: January 2015)

Key Findings: Fortification of Corn Masa Flour with Folic Acid in the United States
The journal Annals of the New York Academy of Sciences published an article about the fortification of corn masa flour with folic acid in the United States and how it can improve health outcomes for Hispanics.
(Published: April 2014)

Key Findings: Lack of Vitamins Containing Folic Acid and Diabetes-Associated Birth Defects
The American Journal of Obstetrics and Gynecology published a CDC study: “Lack of Periconceptional Vitamins or Supplements That Contain Folic Acid and Diabetes Mellitus-Associated Birth Defects.”
(Published: March 2012)

Feature Articles

World Birth Defects Day
March 3rd is World Birth Defects Day, which aims to raise awareness of birth defects, their causes, and their impact around the world. Every year, about 3–6% of infants worldwide are born with a serious birth defect. This means that life-altering conditions like spina bifida and congenital heart defects affect millions of babies and families.
(Published: February 2019)

Folic Acid Helps Prevent Some Birth Defects
Learn how to get healthy before and during pregnancy to increase your chances of having a healthy baby. Plan ahead by getting 400 micrograms (mcg) of folic acid each day.
(Published: January 2019)

Women Need 400 Micrograms of Folic Acid Every Day
The B vitamin folic acid helps prevent birth defects. If a woman has enough folic acid in her body before and while she is pregnant, her baby is less likely to have a major birth defect of the brain or spine.
(Published: December 2014)

Publications of Interest

Lack of historical evidence to support folic acid exacerbation of the neuropathy caused by vitamin B12  deficiency
Am J Clin Nutr. June 2019.
Berry, RJ.
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One-carbon cofactor intake and neural tube defect risk among women meeting folic acid recommendations: A multi-center case-control study
Am J Epidemiol. June 2019;188(6):1136−1143.
Petersen JM, Parker SE, Crider KS, Tinker SC, Mitchell AA, Werler MM.
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Systematic review and Bayesian meta-analysis of the dose-response relationship between folic acid intake and changes in blood folate concentrations
Nutrients. January 2019;11(1).
Crider KS, Devine O, Qi YP, Yeung LF, Sekkarie A, Zaganjor I, Wong E, Rose CE, Berry RJ.
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Trends in multivitamin use among women of reproductive age: United States, 2006–2016
J Womens Health (Larchmt). January 2019;28(1):37−45.
Wong EC, Rose CE, Flores AL, Yeung, LF.
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Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: Have we reached optimal prevention?
Am J Clin Nutr. June 2018;107(6):1027−1034.
Crider KS, Qi YP, Devine O, Tinker SC, Berry RJ.
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Discussing appropriate medication use and multivitamin intake with a healthcare provider: An examination of two elements of preconception care among Latinas
J Womens Health (Larchmt). March 2018;27(3):348−358.
Interrante JD and Flores AL.
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Folic acid education for Hispanic women: The Promotora de Salud model
J Womens Health (Larchmt). February 2017;26(2):186−194.
Flores AL, Isenburg J, Hillard CL, deRosset L, Colen L, Bush T, Mai CT.
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Applying inappropriate cutoffs leads to misinterpretation of folate status in the US population
Am J Clin Nutr. December 2016;104(6):1607−1615.
Pfeiffer CM, Sternberg MR, Hamner HC, Crider KS, Lacher DA, Rogers LM, Bailey RL, Yetley EA.
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Retrospective assessment of cost savings from prevention: Folic acid fortification and spina bifida in the U.S.
Am J Prev Med. May 2016;50(5 Suppl 1):S74−s80.
Grosse SD, Berry RJ, Tilford JM, Kucik JE, Waitzman NJ.
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U.S. women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, National Health and Nutrition Examination Survey 2007 to 2012
Birth Defects Res A Clin Mol Teratol. April 2015;103(6):517−526.
Tinker SC, Hamner HC, Qi YP, Crider KS.

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Assessing the association between the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism and blood folate concentrations: A systematic review and meta-analysis of trials and observational studies
Am J Clin Nutr. March 2015;101(6):1286−1294.
Tsang BL, Devine OJ, Cordero AM, Marchetta CM, Mulinare J, Mersereau P, Guo J, Qi YP, Berry RJ, Rosenthal J,
Crider KS, Hamner HC.
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Updated estimates of neural tube defects prevented by mandatory folic acid fortification – United States, 1995–2011
MMWR Morb Mortal Wkly Rep. January 2015;64(1):1−5.
Williams J, Mai CT, Mulinare J, Isenburg J, Flood TJ, Ethen M, Frohnert B, Kirby RS.
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Supplement use and other characteristics among pregnant women with a previous pregnancy affected by a neural tube defect – United States, 1997–2009
MMWR Morb Mortal Wkly Rep. January 2015;64(1):6−9.
Arth A, Tinker S, Moore C, Canfield M, Agopian AJ, Reefhuis J.
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Historical publications that provided information to help establish CDC’s folic acid recommendations

Prevention of neural tube defects with folic acid in China. ChinaU.S. Collaborative Project for Neural Tube Defect Prevention
N Engl J Med. December 1999;341(20):1485−1490.
Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Want H, Mulinare J, Zhao P, Wong LY, Gindler J, Hong SX, Correa A, Hao L, Gunter E.
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Recommendations for use of folic acid to reduce number of spina bifida cases and other neural tube defects
MMWR Morb Mortal Wkly Rep. September 1992;41(Rr-14):1−7.
Centers for Disease Control and Prevention
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Effectiveness in disease and injury prevention use of folic acid for prevention of spina bifida and other neural tube defects—1983-1991
MMWR Morb Mortal Wkly Rep. August 1991;40(30):513−516.
Centers for Disease Control and Prevention
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Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group
Lancet. July 1991;338(8760):131−137.
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