Results of Folic Acid Fortification in Cereal Grains.





Related Monographs

Consumer Data: Folic Acid
Professional Data: Folic Acid


It was in 1992 that U.S. Public Health Service recommended that all women who were of childbearing age increase their intake of folic acid. Four years later, the US Food and Drug Administration mandated that folic acid be added to cereal grain products. The full implementation of this program was scheduled to have been completed by the beginning of 1998. Reports from various government agencies have indicated that this program has been successful in raising the folate levels in pregnant women and consequently reducing the numbers of related birth defects.
The addition of folic acid to foods and to the diets of pregnant women was endorsed by the American Academy of Pediatrics who stated that women who were capable of becoming pregnant should consume folic acid on a daily basis.1 The Academy estimates that fewer than one in three women consume the recommended amount of folic acid. Results have been positive and there has been a decrease in the incidence of neural tube defects. While it is assumed that this decline is directly related to the fortification of foods, other factors may be involved as well.
One particular study evaluated birth certificate data for live human births in 45 US states and Washington, DC, between January 1990 and December 1999 in order to evaluate the impact of folic acid fortified food on the prevalence of neural tube defects (NTDs) among these births. The reports of spina bifida and anencephaly on the birth certificates before folic acid fortification were compared to the reports on the certificates after folic acid fortification became mandatory. A 19% decline was noted between the two time frames evaluated. NTD prevalence dropped from 37.8 per 100,000 live births before fortification to 30.5 per 100,000 live births following fortification. Women who received only third trimester or no prenatal care were also evaluated. These women also experienced a decline from 53.4 to 46.5 per 100,000 live births. The authors concluded that "a 19% reduction in NTD birth prevalence occurred following folic acid fortification of the US food supply. However, factors other than fortification may have contributed to this decline."2


1. Committee on Genetics, AMERICAN ACADEMY OF PEDIATRICS, Folic Acid for the Prevention of Neural Tube Defects. Pediatrics. Aug 1999;104:325-327.
2. Honein MA. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA. Jun 2001;285(23):2981-6.