• What are NTDs?
  Neural tube defects, or NTDs, are birth defects that affect the neural tube, the structure that becomes the brain and spinal cord. There are several different types of NTDs. Spina bifida and anencephaly account for 90 percent of all NTDs. Encephalocele accounts for the remaining 10 percent.
  
  Spina bifida is a birth defect of the spinal cord that is sometimes called "open spine." Spina bifida can be a mild defect, but most commonly it is a serious condition involving muscle paralysis, loss of feeling, infection, loss of bowel and bladder control, and the risk of impaired mental development. Spina bifida is the leading cause of childhood paralysis in the United States.
  
  Anencephaly is a birth defect that results in babies being born with underdeveloped brains and incomplete skulls. Most babies born with anencephaly do not survive more than a few hours after birth.
  
  Encephalocele is a birth defect that results in a hole in the skull through which brain tissue protrudes. Babies with encephalocele usually live, but they often suffer varying degrees of mental disability.
• When and why do NTDs happen?
  NTDs occur very early in a baby’s development, between the 17th and 30th day after conception. In addition to folic acid deficiency, other factors may play a part; these factors include:
  • Environment
  • Genetics
  • Socioeconomic status
  • Maternal diabetes
  • Maternal weight
  • Alcohol use by the mother
    
• How many pregnancies are affected by these birth defects?
  In the United States, about 3,000 pregnancies per year are affected by an NTD. 
  
• Who is at risk of having a baby with an NTD?
  Any woman can have a baby with an NTD.
  
  At particular risk are women who:
  • Have an NTD themselves or have a close relative with one
  • Use valproic acid or carbamazepine to treat seizure disorders
  • Are of Hispanic ethnicity
  • Have diabetes
  
  A woman who has had a previous NTD-affected pregnancy is at increased risk of having another such pregnancy. She should consult her doctor before her next pregnancy about the amount of folic acid she should take. Studies have shown that a larger dose of folic acid—4.0 milligrams (4,000 micrograms) beginning at least one month before pregnancy and through the first trimester—reduces the risk of having another affected pregnancy by about 70 percent.
• Will prenatal tests tell me if my pregnancy might be affected by an NTD?
  Probably, but not always. The triple screen blood test, which is most often done between 16 and 18 weeks after the woman’s last menstrual period, can detect an increased risk of NTDs. Combining the triple screen test with two other screening procedures—ultrasound and amniocentesis—increases the reliability of the test results.
• Can NTDs be prevented?
  If all women in the United States took 400 micrograms of folic acid every day throughout their childbearing years, up to 70 percent of neural tube defects could be prevented.
  
  The March of Dimes recommends that all women who can become pregnant:
  • Take a multivitamin with 400 micrograms of folic acid every day
  • Eat a healthy diet that includes foods high in folic acid, such as enriched grain products (including certain breakfast cereals), beans and other legumes, leafy green vegetables, and orange juice.

Folic Acid and Folate: What's the Difference?

• What is folic acid?
  Folic acid is a B vitamin that is an essential nutrient for proper growth and development. It may reduce a woman’s risk of having a baby with a neural tube defect (NTD) when consumed before conception and during the early weeks of pregnancy.
• What is folate?
  Folate is another form of the B vitamin folic acid that occurs naturally in food.
• What is the difference between folic acid and folate?
  There are two important differences between folic acid and folate:
  1. Where they are found. Folic acid is the synthetic form of the vitamin that is used in supplements and fortified foods. Folate is found naturally in foods, such as beans and other legumes, leafy green vegetables and orange juice.
  2. How the body uses them. While the body almost completely uses synthetic folic acid, it only partially uses natural folate
• How can I get enough folic acid?
  You should take a multivitamin containing 400 micrograms of folic acid every day and eat a healthy diet that includes foods high in folic acid, such as enriched grain products (including certain breakfast cereals), beans and other legumes, leafy green vegetables, and orange juice.
• Who should take folic acid supplements?
  At least half of all pregnancies in the United States are unplanned or incorrectly timed, and neural tube defects (NTDs) occur before most women know they are pregnant. For this reason, you should take 400 micrograms of folic acid in a vitamin supplement if you are a woman who is:
  • In your reproductive years
  • Capable of becoming pregnant
  • Sexually active

Getting Enough Folic Acid and Where to Find It

• How can I be sure I get enough folic acid?
  Take a daily vitamin supplement and eat a healthy diet. The best source of folic acid is a vitamin supplement. Most multivitamins contain 400 micrograms of folic acid, or you can take a separate folic acid supplement.
• Which foods contain folic acid?
  Listed below are some examples of foods that contain folic acid. The recommended daily value (RDV) of folic acid for a woman of childbearing age is 400 micrograms.

• Which fortified breakfast cereals contain 100% of the recommended daily value of folic acid?
  Here are some cereals that contain 100% of the recommended daily value of folic acid:
  • Whole Grain Total, Total Corn Flakes, Total Raisin Bran and Multi-Grain Cheerios Plus (General Mills)
  • Product 19, Just Right with Fruit and Nut and Smart Start (Kellogg’s)
    
    Disclaimer: These cereals are high in folic acid, but check the nutritional information on the label to ensure that your other nutritional needs are met. The March of Dimes does not endorse any individual brands or cereal manufacturers.
    
• How can I store and prepare foods to preserve folate? 
  • Whenever possible, eat vegetables raw.
  • Refrigerate fresh fruits and vegetables, but don’t keep them long. The longer they are stored, even in the refrigerator, the more folate will be lost.
  • Cooking water destroys folate. Steam or stir-fry vegetables instead of boiling them.
  • Dried beans and peas, even when cooked for a long period of time, are good sources of folate.
    
    November 2005