Since the benefits of early supplementation have been established so clearly, statistics may or may not ease your anxiety. “The risk of neural-tube defects in the U.S. is one in 1,000,” Mills says.
If you or your doctor is concerned, you may wish to consider prenatal testing. The maternal alpha-fetoprotein (AFP) test is a simple blood test typically done at 16 to 18 weeks of pregnancy. It measures alpha-fetoprotein, a substance produced by the fetus and secreted into the amniotic fluid, eventually entering the mother’s blood. Abnormally high amounts of AFP can indicate a neural-tube defect — but not always. It is an imperfect test. If a woman has an elevated AFP, her doctor will usually retest and then do an ultrasound. If no explanation is found, an amniocentesis may be performed.
Why Aren’t We Doing It?
So what gives? What’s so difficult about taking a pill and eating your fruits and veggies? It’s the hassle factor, according to Mills. You have to go out and buy the pills, he notes, and then, of course, remember to take
Jo Ann Hattner, R.D., a spokesperson for the American Dietetic Association and clinical nutritionist at Stanford University Medical Center in Palo Alto, Calif., seems to agree. “We’re bombarded with messages [about health],” she says, “and all too often, folic acid slips through the cracks.” So Hattner tries to convince women that the recommendation can be achieved with little hassle.
Eat the Right Things
“It’s easy [to take in folic acid] if you remember to focus on citrus foods, dark green leafy vegetables and whole-grain cereals,” Hattner says. A half-cup of boiled spinach has 130 micrograms of folic acid; a medium orange 45. “Women need to plan ahead, think about it a little more,” she adds. Cut down on processed foods, she advises, and visit the produce department.
By January 1998, under Food and Drug Administration regulations issued in 1996, folic acid was to be added to enriched cereal and grain products, such as flour, corn meal, pasta and rice. And breakfast cereals can be fortified with up to 400 micrograms per serving.
Following the folic acid recommendation may be even more important for some women than others. A 1997 study published in the journal Lancet by Mills of the NIH and his colleagues showed that some women are predisposed to having lower levels of folic acid in their red blood cells than most women, although the experts don’t understand why. About 5 percent to 15 percent of women could be affected, Mills estimates.
Although there is a test that can measure blood levels of folic acid, Mills doesn’t recommend routine testing because women should take the same action regardless of their test results. “Just make sure to get the recommended amounts,” he says.
Many public-health experts say awareness is growing, albeit slowly. “It is moving in the right direction, but we are not there yet,” says Godfrey Oakley, M.D., director of the division of birth defects and developmental disabilities for the CDC. The foods chosen for fortification — breads and cereals — are eaten by most people, so the hope is that all women will soon be getting plenty of folic acid during their childbearing years.
Meanwhile, Oakley and his wife have hatched a plan they hope will catch on: “Every time you get invited to a wedding,” he suggests, “take a year’s supply of folic acid and give it to the bride.”