Itikala PR, Ruuska SE, Oakley GP, Kloeblen-Tarver AS, Klein L. Periconceptional Intake of Folic Acid Among Low-Income Women. JAMA. 2000;283(23):3074. doi:10.1001/jama.283.23.3068j
To the Editor: The US Public Health Service in 1992 and the Food and Nutrition Board of the Institute of Medicine in 1998 recommended that all women of reproductive age consume 400 µg of synthetic folic acid daily, whether or not they are planning a pregnancy.1,2 These recommendations were issued to prevent spina bifida and anencephaly. By 1997, only 20% of newly pregnant women in the United States were consuming the recommended amount of folic acid. Low-income women, on average, consume vitamin supplements even less frequently.3 We sought to estimate how many low-income women in Atlanta are following the current folic acid recommendations.
In fall 1999, we interviewed 150 African American inner-city women who came to the Grady Memorial Hospital for their first prenatal visit to determine their use of folic acid supplements before and during pregnancy. We also obtained information about dietary habits and other potential predictors of synthetic folic acid consumption. The Human Investigations Committee of Emory University approved the study and all participating women gave informed consent.
We found that 6 (4%) of the 150 women reporting taking a synthetic folic acid supplement properly prior to becoming pregnant.
Eight years after the Medical Research Council Vitamin Study demonstrated that folic acid prevents spina bifida and anencephaly,4 most low-income women in our sample were still not receiving appropriate folic acid supplementation. Higher levels of food fortification may help to ensure that all women consume the recommended daily levels of folic acid. The Food and Drug Administration has projected that the current low level of folic acid food fortification in the United States will result in only approximately 25% of women of reproductive age consuming 400 µg of synthetic folic acid daily from all sources, including supplements.5
On January 13, 2000, the UK Committee on Medical Aspects of Food and Nutrition Policy published a recommendation for folic acid fortification of grains in the United Kingdom at a concentration twice that used in the United States.6 Our findings suggest that these higher standards should also be adopted in the United States.