Which food would the nurse recommend to a pregnant client to most significantly increase the clients intake of folic acid?

All women of reproductive age should get 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent neural tube defects (NTDs). NTDs are major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).

Recommendations

The CDC, Institute of Medicine, and U.S. Preventive Services Task Force all recommend that women of reproductive age take folic acid to help prevent NTDs.

History of folic acid recommendations in the United States

Research Timeline

This documentary short chronicles the hard work behind folic acid fortification in the United States and its positive effects on the health and well-being of so many children and families.

Watch the video »

Researchers have studied the association between low folate levels in women and neural tube defects as early as 1965.1 Neural tube defects are major birth defects of a baby’s brain (anencephaly) and spine (spina bifida). A number of studies showed that taking folic acid before and during the first weeks of pregnancy helped to lower the chance of neural tube defects.1

1991

CDC recommended that women who had a pregnancy affected by a neural tube defect consume folic acid before planning to become pregnant again.2

1992

The U.S. Public Health Service recommended that all women who could become pregnant get 400 micrograms (mcg) of folic acid each day to prevent neural tube defects.3

1998

The Institute of Medicine’s Food and Nutrition Board of the National Academy of Sciences recommended that all women who can become pregnant get 400 mcg of folic acid each day, in addition to consuming food with folate from a varied diet, to reduce the risk of neural tube defects.4

The U.S. Food and Drug Administration (FDA) required that manufacturers add folic acid to cereal grain products labeled as ‘enriched’ to lower the chance of neural tube defects from occurring. This is mandatory fortification.5

• Mandatory fortification is the most effective public health strategy to help prevent neural tube defects because
  • Almost half of all pregnancies are unplanned;6
  • Folic acid is only effective before and during the first weeks of pregnancy, often before a woman knows she is pregnant; and
  • It is not necessary to remember to take a vitamin each day before becoming pregnant.

2016

Hispanic/Latina women are more likely to have a child born with a neural tube defect compared to non-Hispanic white and non-Hispanic black women and lower median total folic acid (FA) intake.5-7 To address this health disparity and help more women get the recommended daily value of folic acid each day, the FDA allowed folic acid to be added voluntarily to corn masa flour. This is voluntary fortification. Adding folic acid to corn masa flour will

• Increase the average amount of daily folic acid women get;
• Help more women, specifically Hispanics/Latinas, get the recommended daily value of folic acid;8 and
• Prevent an estimated 40 (range of 0-120) additional Hispanic infants per year from being born with an NTD.9

Data from 2017-2018 have shown that voluntary fortification with folic acid has not yet had an impact on the folate status among Hispanic women of reproductive age in the United States.10 It is important to check the nutrition label on food packaging to see if it contains folic acid, as corn masa flours may or may not contain folic acid.

More information

Learn more about folic acid here

For more information, visit the Frequently Asked Questions page.

You can also contact CDC-INFO in English or Spanish:

• 1-800-CDC-INFO (800-232-4636)
• TTY: 1-888-232-6348
• In English
• En español

References

1. Crider KS, Bailey LB, Berry RJ. Folic acid food fortification–its history, effect, concerns, and future directions. Nutrients. 2011;3(3):370–384.
2. Centers for Disease Control and Prevention (CDC). Use of folic acid for prevention of spina bifida and other neural tube defects–1983–1991. MMWR Morb Mortal Wkly Rep. 1991;40(30):513–516.
3. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep. 1992;41(RR-14):1–7.
4. Institute of Medicine (US). Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington (DC): National Academies Press (US); 1998.
5. Williams J, Mai CT, Mulinare J, et al. Updated estimates of neural tube defects prevented by mandatory folic acid fortification – United States, 1995–2011. MMWR Morb Mortal Wkly Rep. 2015;64(1):1–5.
6. Centers for Disease Control and Prevention (CDC). Racial/ethnic differences in the birth prevalence of spina bifida – United States, 1995–2005. MMWR Morb Mortal Wkly Rep. 2009;57(53):1409–1413.
7. Canfield MA, Mai CT, Wang Y, et al. The association between race/ethnicity and major birth defects in the United States, 1999–2007. Am J Public Health. 2014;104(9):e14–23.
8. Flores AL, Cordero AM, Dunn M, et al. Adding folic acid to corn masa flour: Partnering to improve pregnancy outcomes and reduce health disparities. Prev Med. 2018;106:26–30.
9. Tinker SC, Devine O, Mai C, et al. Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. Birth Defects Research A Clin Mol Teratol. 2013;97(10):649–657.
10. Wang A, Rose CE, Qi YP, Williams JL, Pfeiffer CM, Crider KS. Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018). Nutrients. 2021, 13(4), 1325; //doi.org/10.3390/nu13041325.

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When teaching a client who is planning to get pregnant about the need to increase folic acid which food can the nurse suggest?

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