1. This presentation was developed by the Missouri Department of Health and Senior Services through a grant from the Centers For Disease Control and Prevention FOLIC ACID: For The Future Missouri Department of Health and Senior Services

2. 2 Course Outline What is folic acid? How do you get folic acid? Who needs folic acid? How do neural tube defects occur? What is a neural tube defect? What are the recommended levels of folic acid? What can you do?

3. 3 What Is Folic Acid? Folic acid is the synthetic form of a water soluble B vitamin that is needed to: Make new cells/cell division Make normal-shaped red blood cells Help prevent anemia Help prevent birth defects Help prevent heart disease, stroke and certain cancers.

4. 4 How Do You Get Folic Acid?

5. 5 Foods Naturally High in Folic Acid Liver Nuts and peanut butter Dried peas or beans Juices: orange, pineapple, tomato Fruits: orange, avocado, cantaloupe Leafy green vegetables

6. 6 Fortified Grain Products Just right with crunchy nuggets Multi-grain cheerios plus Product 19 Special K Whole grain total Total corn flakes Total raisin bran SOME of the cereals with 100% of the recommended daily value of folic acid per serving:

7. 7 Easiest Way! Take a multi- vitamin with 400 mcg. of synthetic folic acid every day

8. 8 Who Needs Folic Acid? All women aged 14-50 who COULD become pregnant Pregnant women Everyone, including men

9. 9 How Do NTDs Occur? Baby’s brain and spine fail to close completely Neural tube closing properly to form spinal column and brain.

10. 10 What Is a Neural Tube Defect? Spina Bifida – 60% Anencephaly – 30% Encephalocele – 10%  Neural tube defects (NTDs) are the second most common cause of infant mortality.  NTDs occur in 1 out of every 2,000 babies.

11. 11 AnencephalyAnencephaly Upper end of the neural tube fails to close Brain either never develops or is totally absent 50% stillbirth rate Usually fatal, 5% survive one week

12. 12 EncephaloceleEncephalocele Defect of the skull – smaller defect than anencephaly Protrusion of brain or skin-covered brain Rarer than the other types of NTDs Overall mortality rate about 29%

13. 13 Spina Bifida Neural tube fails to close properly: Neural tube fails to close properly: Occurs by 28 gestational days Associated problems: Associated problems: Hydrocephalus Clubfoot Vertebral anomalies Renal anomalies Requires surgery 24-48 hours after birth Requires surgery 24-48 hours after birth

14. 14 Financial Costs: Financial Costs: Average estimated lifetime cost of $532,000 for each infant born with spina bifida (CDC 1999) adds an estimated 19 million dollars every year to Missouri resident lifetime costs associated with spina bifida. Physical Costs: Physical Costs: Possible paralysis (the leading cause of childhood paralysis), bowel and bladder control problems, learning disabilities, hydrocephalus, surgical procedures, latex allergies, increased health problems with age Emotional Costs: Emotional Costs: Miscarriage, stillbirth, infant mortality (death before 1st birthday), disability, feeling “different” The High Cost of NTDs

15. 15 Factors Associated With Increased Risk of NTDs... Family history of NTD A previous pregnancy affected with NTD Maternal insulin- dependent diabetes Maternal obesity Anti-epileptic drugs (Valporic Acid/Kepakene, Carbamazapine) Lower socioeconomic/educational level Race/ethnicity Geography Exposure to high temperatures in pregnancy

16. 16 What Are the Recommended Levels of Folic Acid? U.S. Public Health Service recommendation: “All women of childbearing age capable of becoming pregnant should consume 400 micrograms (or 0.4 milligrams) of folic acid daily.”

17. 17 CDC Recommendation “All women of childbearing age in the United States who are capable of becoming pregnant should consume 400 mcg. of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with a Neural Tube Defect. Women who have had prior NTD-affected pregnancy are at risk of having a subsequent affected pregnancy.”

18. 18 Folic Acid For Women All women of childbearing age should receive 400 micrograms (0.4 mg) of folic acid daily. Women who have had a previous child with NTD should receive 4000 micrograms (4 mg) of folic acid daily.

19. 19 Folic Acid Awareness: Survey of Missouri Women Age 18-44 1999 Missouri BRFSS

20. 20 Folic Acid Awareness: Survey of Missouri Women Age 18-44 The survey highlights the following characteristics of women in the survey who were less likely to take a daily folic acid supplement. Women aged 18-24 (37.1%) Annual income less than $15,000 (27.1%) Less than a High School diploma (19.2%) High School diploma (39.1%) 1999 Missouri BRFSS

21. 21 Folic Acid Awareness: Survey of Missouri Women Age 18-44 1999 Missouri BRFSS

22. 22 Blood Pressure Birth Defects Other Strong Bones Unknown Reasons for Taking Folic Acid 1999 Missouri BRFSS 3.7 36.9 25.8 19.1 14.5

23. 23 What Can You Do? Take a multivitamin with 400 mcg. of folic acid every day for your health. Help spread the message about the need for folic acid for health and to reduce birth defects.

24. 24 Resource List Missouri Department of Health and Senior Services, Division of Nutritional Health and Services, 573-522-9144 http://www.health.mo.gov/living/wellness/nutrition/nu tritionpregnancy/index.php Centers for Disease Control and Prevention www.cdc.gov/ncbdd/folicacid/index.html www.cdc.gov/ncbdd/folicacid/index.html March of Dimes 1-888-MODIMES www.modimes.com www.modimes.com