FOLIC ACID
August 19, 2002

Susan Dentzer looks at the causes of spina bifida and efforts to prevent the disease by encouraging women to take more folic acid. The NewsHour Health Unit is funded by a grant from The Henry J. Kaiser Family Foundation.

 

Online Focus: Folic Acid-- Preparing for a Healthy Pregnancy Browse the NewsHour's coverage of health   The March of Dimes	DAN WALLACE: (talking to young daughter) Kick the ball! SUSAN DENTZER: Like most parents, Kerry and Dan Wallace consider their own little girl, Kate, to be a miracle. KERRY WALLACE: It's absolutely a blessing, and we enjoy every day-- absolutely every day. She's hilarious. DAN WALLACE: She's a lot of fun. She's a great kid. She's smart, she's a challenge.
	Avoiding spina bifida
	SUSAN DENTZER: The Wallaces have more reasons than most parents to think their child is special. That's because 22-month-old Kate was born completely normal, even though both Kerry and Dan were born with a serious birth defect called spina bifida. The condition takes shape in the first month of pregnancy, and involves the part of a human embryo that eventually forms the brain and spinal cord. Spina bifida has left Kerry paralyzed from the waist down, and Dan with a slight limp, as well as bladder and bowel incontinence. DAN WALLACE: Basically, at a younger age I did not even want to consider having children because I was so afraid that I would pass along a disability that could be worse than mine. After doing enough research and after talking to enough people, we decided that this is really something that we could accomplish, and I changed my mind, and I'm really glad that I did. DAN WALLACE: Good kick! SUSAN DENTZER: What helped to produce a healthy baby for the Wallaces was the simplest of medical interventions: Taking a vitamin called folic acid, or vitamin B-9. Found naturally in foods like spinach and citrus fruits, it's also available on its own in tablet form, or as part of a typical multivitamin. Scientists believe that folic acid plays a crucial role in the formation of human DNA. As a result, inadequate supplies of folic acid in the body are increasingly thought to contribute to a range of conditions, from birth defects like spina bifida and cleft palate to adult diseases like colon cancer and Alzheimer's. SPOKESPERSON: And up, up, exhale out! SUSAN DENTZER: Despite today's emphasis on healthy pregnancies, many women still are not taking folic acid before and after pregnancy, even though the connection between insufficient amounts of the vitamin and spina bifida has been understood for years. Because of her and her husband's condition, Kerry Wallace was told by her physician to take four milligrams of folic acid daily. She was to start three months before trying to become pregnant-- that's ten times the 400 microgram daily dose now recommended for all normal women of reproductive age. SPOKESPERSON: The markets are down... SUSAN DENTZER: For television anchor Judy Woodruff, that government recommendation about folic acid consumption, first introduced in 1992, came too late. Woodruff, now with CNN, and formerly a correspondent with the NewsHour, gave birth to a son with spina bifida in 1981. JUDY WOODRUFF: Suddenly our world completely changed. We had a child with a birth defect, and one we could barely pronounce, one that our friends had never heard of, our family had never heard of, we didn't know anything about. SUSAN DENTZER: Surgeons operated on woodruff's son, Jeffrey, when he was just 15 hours old, to close up the spine and prevent infection. Later, he developed a common related condition called hydrocephaly, or water on the brain. JUDY WOODRUFF: So at ten months, Jeffrey had a shunt put in, and essentially what that is, is a tube that runs from the inside of the skull to drain excess cerebrospinal fluid down, and the tube goes under the skin and along the neck, in his case, and down into his abdominal cavity. SUSAN DENTZER: It was only long after his birth that woodruff learned that a shortage of folic acid early in pregnancy may have caused or contributed to her son's condition. JUDY WOODRUFF: I've now come to understand over the years-- we're now what, 2002; Jeffrey is 20 years old-- I've come to understand now that it is believed that with the right amount of folic acid, you can... they can prevent... you can prevent up to 75 percent of babies with spina bifida. You can imagine how that makes you feel, to know that maybe there was something that you could have done that would have changed the life of your child and made him healthy. It's just... I can't put it into words.
	Promoting folic acid
	SUSAN DENTZER: Dr. Victor Klein is the obstetrician who put Kerry Wallace on a high dose of folic acid before and during her pregnancy. Recently he used ultrasound equipment to demonstrate how the neural tube develops into a normal spine in a healthy pregnancy. His patient Lori Salti, age 33, is pregnant with twins. DR. VICTOR KLEIN: Okay, we're looking at baby "A" now, and there's a beautiful picture of the spine. See, it looks like railroad tracks right there. You see like a column of two white lines. And this appears to be a totally normal spine, in which the spinal cord at this point in time is totally encased in the bony parts of the spine, and it looks totally normal. We'll look at the other baby also. This one is bouncing around a lot more. But just looking right there, and I'm going to freeze it for you... so we can see that both babies "A" and "B" have normal spines based on limitations of sonography. So everything looks great. LORI SALTI: Oh, that's wonderful. SUSAN DENTZER: Now, contrast that normal spine with what happens when defects occur in the so- called "neural tube." In embryos, that's the predecessor of what ultimately becomes the brain and spinal cord. In some pregnancies, the neural tube fails to close properly, usually at 17 to 30 days after conception. If the upper portion isn't fully enclosed, the fetus develops anencephaly, or absence of part or all of the brain. This condition usually kills babies during pregnancy or soon after birth. When the lower part of the tube fails to close, the result is spina bifida, the Latin phrase for "split spine." Depending on where the damage occurs, children with spina bifida may be only mildly impaired or completely paralyzed. They can also have other serious problems, like the inability to control their bladder and bowels. JUDY WOODRUFF: Most of the spina bifida kids have that, and it's embarrassing to talk about. It's very difficult for a family to deal with. I mean, you go out of the house and you have a problem with the child, and yet that's part of their life. SUSAN DENTZER: For years the federal Centers for Disease Control and Prevention has led efforts to boost folic acid consumption among women of reproductive age. Dr. Godfrey Oakley, a birth defects expert, spearheaded that CDC program. DR. GODFREY OAKLEY: It has been trying to make other people understand that if we get enough folic acid to women all over the world, we can eradicate folic acid- preventable birth defects the same way as we're about to eradicate polio. SUSAN DENTZER: Oakley, who sports a green lapel ribbon to raise folic acid awareness, says the incidence of neural tube defects nationwide has been falling. That's thanks in part to widespread use of multivitamins, and in part to a decision by the federal government in 1998 to require manufacturers to fortify grains, breads, and cereals with extra amounts of folic acid. DR. GODFREY OAKLEY: Spina bifida and anencephaly have dropped about 20 percent. We thought it would drop more, and we still think that if we get more folic acid to women, either through putting more in flour or having more women take supplements or eat breakfast cereals with folic acid in them, we'll do even a better job of prevention than we are currently doing. SUSAN DENTZER: And experts say a better job of prevention is needed, since there are still about 1,700 babies born annually in the U.S. with spina bifida, and about a half million worldwide. ANNOUNCER: This bean contains a nutrient vital to the birth of a healthy baby.
	Changing women's behavior
	SUSAN DENTZER: For several years the National March of Dimes Foundation has conducted print and television campaigns to boost awareness of folic acid, as well as annual polls to measure the effect. Jennifer Howse heads the National March of Dimes Foundation. JENNIFER HOWSE: The awareness numbers have grown substantially since 1995, from 52 percent of women who said that they were aware that folic acid was somehow beneficial to them, to 80 percent of women who say yes, folic acid is beneficial. That's the good news. The challenging news is that still only about one-third of women are taking a daily multivitamin. So there is a substantial gap between awareness and a behavior change. SPOKESPERSON: When you look at multivitamins or Flintstones, it doesn't say B-9, it says folic acid. SUSAN DENTZER: To help close that gap, the March of Dimes sponsors educational sessions with high school students. During a recent one, nurse educator Karla Damus spoke with juniors and seniors in a health class at a Bronx high school. KARLA DAMUS: Eight out of ten teenagers who get pregnant didn't expect to get pregnant, so they had unintended pregnancy. If you're not expecting to get pregnant, you may not do all the things that you could be doing, the men and the women, to have a healthy pregnancy. SUSAN DENTZER: Damus says it's up to healthcare providers like her to get the word out about folic acid. KARLA DAMUS: We need to use every opportunity, not just for women's health care, but in emergency rooms, in just normal pediatric care, with our adolescents. Everyone needs to get the message, and it isn't a message that you only do this when you are of reproductive age. It's the message that you need this from puberty until death, and you'll live a lot healthier, because there are so many health benefits. JUDY WOODRUFF: For every other family, for every other woman out there who is even thinking about getting pregnant, take your folic acid. Take your B vitamins, because if you can possibly prevent the heartache that comes with having a child who suffers in any way, you want to do it.