Sunday, January 17, 2010

Most women of child-bearing age don't know how much folic acid to take

From Medill Reports in Chicago:


Jennifer Jobrack did everything right for her first pregnancy.

She took prenatal vitamins. She got enough sleep and exercise. She even began consuming the recommended levels of folic acid before she conceived, an insurance policy against brain and spine birth defects.

But 17 weeks into the pregnancy, she and her husband received a shock of seismic proportions. Their baby had anencephaly, a rare and fatal birth defect in which parts of the brain, skull and scalp fail to form. So in December 2003, Jobrack and her husband terminated the pregnancy.

“I think you always carry that grief, even as you celebrate successful pregnancies later,” said Jobrack, 42. “It stays with you. I think it probably added a significant amount of anxiety in later pregnancies because I wasn’t sure I could produce a healthy baby.”

It turned out Jobrack hadn’t taken enough folic acid to counteract a genetic mutation. She and her doctors didn’t discover she had the mutation until the spring of 2009. Despite that, she began taking 10 times the recommended amount of folic acid on her doctor's advice immediately after she and her husband lost their first child.

Folic acid is a B vitamin that has been shown to help prevent birth defects of the brain and spinal cord, including anencephaly. There’s just one catch – you need to be getting the recommended 400 micrograms a day at least a month before conception and only about 12 percent of women of childbearing age know that, according to the Centers for Disease Control and Prevention and the March of Dimes Foundation.

The situation gets even stickier when one considers that half of pregnancies in the United States are unplanned.

“We have in the past had a spokeswoman who’s an OB say, ‘I tell young girls if they’re even thinking about having sex to take folic acid,’” said Judi Adams, a registered dietician and the president of the Grain Foods Foundation, based in Colorado.

The Grain Foods Foundation and the March of Dimes have partnered to promote January as the National Birth Defects Awareness month to increase awareness that folic acid can prevent neural tube defects.

It’s an important message since only 40 percent of women of childbearing age in the United States take a vitamin with folic acid each day, according to a 2007 March of Dimes Gallup survey.

Up to 70 percent of all neural tube birth defects – the most common of which are anencephaly and spina bifida – could be prevented if all women of childbearing age did exactly what Jobrack was doing: taking her folic acid, according to the March of Dimes.

Doctors can determine the appropriate amount of folic acid needed if a mother has an increased risk such as Jobrack’s genetic mutation.

The mutation – methylenetetrahydrofolate reductase – prevents the body from metabolizing folic acid. This means Jobrack needs a much higher amount of folic acid in her body to provide a protective level that can prevent neural tube defects.

Jobrack said the success of the human genome project in 2003 helped her doctors uncover the roots of her problem in the spring of 2009.

“It’s really fascinating to me that they’re now able to pinpoint what happened,” Jobrack said. “For five years I was wondering what happened when I was doing everything I was supposed to.”

Jobrack is currently 30 weeks pregnant with her second child. Her first child, a son, was born healthy in May 2005. She’s currently consuming 4,000 micrograms of folic acid a day in addition to a prenatal vitamin.

Although her case is rare, she’s begun sharing her story to enlighten other women about the importance of folic acid.

“For many years I didn’t know how to talk about this and it’s important to talk about it,” she said. “There are so many people who do the right things and this still happens.”