Key Findings: Folic acid fortification continues to prevent neural tube defect

Pregnant woman in a park.

CDC’s Morbidity and Mortality Weekly Report published a new study looking at how many serious birth defects of the brain and spine, called neural tube defects (NTDs), have been prevented since the U.S. Food and Drug Administration required that all enriched grain products be fortified with folic acid. Using data from birth defects tracking systems, researchers found that since folic acid fortification, about 1,300 babies are born each year without an NTD who might otherwise have been affected. Folic acid fortification is an important way to help prevent NTDs. Unfortunately, even with folic acid fortification, not all women of reproductive age are getting the recommended amount of folic acid. This puts them at risk for a pregnancy affected by an NTD. Additional public health interventions targeting these women could help reduce the number of babies born each year with an NTD. You can read the article here.

Main Findings

  • Mandatory folic acid fortification of cereal grain products has helped about 1,300 U.S. babies to be born without an NTD each year.
  • The birth prevalence of NTDs (proportion of babies in the population born with an NTD) has decreased by 35% in the United States, since folic acid fortification was required in 1998.
  • The number of babies born with an NTD each year differs by the mother’s race/ethnicity. Hispanic mothers continue to be at the highest risk for having a baby with an NTD.

About this Study

The aim of this study was to estimate the number of NTDs each year in the United States since mandatory folic acid fortification in enriched grains.

  • Authors used information from birth defects tracking systems to estimate the number of babies with an NTD in the years before and after folic acid fortification (1995-2011).
  • The decline in the prevalence of NTDs during the period after fortification suggests that folic acid fortification efforts have led to the prevention of many but not all NTDs.


CDC urges all women who are capable of becoming pregnant to get at least 400 mcg of folic acid every day. It is especially important for women to get this amount of folic acid at least one month before becoming pregnant to help prevent NTDs. Women can get folic acid in these ways:

  1. Take a vitamin containing 400 mcg of folic acid every day.
  2. Eat a bowl of breakfast cereal every day that has 100% of the daily value of folic acid.
  3. Eat a diet with plenty of fortified grains and foods like beans, peas, and leafy greens, which are rich in folate, the natural form of folic acid in foods.

CDC’s Activities: Folic Acid Fortification and Neural Tube Defect Prevention

CDC is working to address folic acid fortification and NTD prevention through the following activities:

  • Research: CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (births 1997-2011) and the Birth Defects Study To Evaluate Pregnancy exposureS (current births). These studies work to identify potential risks for having a baby with birth defects and to answer questions about the safety of some medications taken during pregnancy.
  • Tracking: CDC funds and coordinates the Metropolitan Atlanta Congenital Defects Program (MACDP). CDC also funds 14 population-based state tracking programs. Birth defects tracking systems are vital to help us find out where and when birth defects, like anencephaly and spina bifida, occur and whom they affect.
  • Prevention efforts: Current fortification efforts should be maintained to prevent NTDs from occurring. There are still opportunities for prevention among women with lower folic acid intakes, especially among Hispanic women, to further reduce the prevalence of NTDs in the United States.

More Information

Key Findings Reference

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.

Key Terms

Neural tube defects (NTDs): NTDs are serious birth defects of the brain, spine, or spinal cord. The two most common NTDs are spina bifida and anencephaly. NTDs form in the first few weeks of pregnancy, often before a woman even knows she is pregnant.

Folic acid fortification: Folic acid is a B vitamin that can help prevent certain birth defects, including NTDs. In 1998, the U.S. Food and Drug Administration required that folic acid be added to enriched grain products (such as bread, pasta, rice, and cereal). This is called fortification.