Folic acid use: facts and figures


Folic acid helps prevent some birth defects

Neural tube defects (NTDs) are serious birth defects that occur early in pregnancy when the brain and spinal cord do not form properly. See MN data on neural tube defects.

More than half of NTDs can be prevented if women eat foods high in folate and/or take a folic acid supplement every day, whether or not they are planning to get pregnant. Good food sources of folate are beans, legumes, dark leafy greens, asparagus, broccoli, citrus fruits, seeds and nuts, and liver.

The Centers for Disease Control and Prevention recommends all women between 15 and 45 years of age consume 400 micrograms of folic acid daily to prevent NTDs.


Neural tube defect rates for 19 States

Source: National Center on Birth Defects and Developmental Disabilities (NCBDDD ) and contributing programs based in Arkansas, Arizona, California, Colorado, Georgia, Illinois, Iowa, Kentucky, Maryland, New Jersey, New York, North Carolina, Oklahoma, Puerto Rico, South Carolina, Texas, Utah, West Virginia, and Wisconsin. Published in CDC MMWR.
Source: National Center on Birth Defects and Developmental Disabilities (NCBDDD ) and contributing programs based in Arkansas, Arizona, California, Colorado, Georgia, Illinois, Iowa, Kentucky, Maryland, New Jersey, New York, North Carolina, Oklahoma, Puerto Rico, South Carolina, Texas, Utah, West Virginia, and Wisconsin. Published in CDC MMWR.

Beginning in 1997, folic acid was added to grains and cereals (fortified) to prevent neural tube birth defects. There was a slight decrease when folic acid fortification was optional (1997-1998) and a continuing decrease when fortification was mandatory (1999 onward).


Pre-pregnancy folic acid use in MN mothers

Source:  Minnesota PRAMS 2009-2011.
Source: Minnesota PRAMS 2009-2011.

Folic acid supplementation during the month before pregnancy was defined as taking a multivitamin, prenatal vitamin, or folic acid vitamin every day of the month before pregnancy ("During the Month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin or a folic acid vitamin?").

In Minnesota, 36% of PRAMS respondents took folic acid daily. Nationally, daily folic acid use during the month before pregnancy was reported by 30% of women in 29 states (Source).


Daily folic acid use

Source: Minnesota PRAMS 2009-2011. "Hispanic" means Hispanic, of any race. 
Source: Minnesota PRAMS 2009-2011.
Source: Minnesota PRAMS 2009-2011.
Source: Minnesota PRAMS 2009-2011. Poor: income under the federal poverty levels (FPL). Near-poor: income 101% - 185% FPL. Not poor: income above 185% FPL.
Source: Minnesota PRAMS 2009-2011. Poor: income under the federal poverty levels (FPL). Near-poor: income 101% - 185% FPL. Not poor: income above 185% FPL.

Hispanic &American Indian women less likely to take folic acid

In Minnesota, Hispanic women report lower consumption of folic acid (22%) compared to non-Hispanic white women (40%). To target Hispanic women who have inadequate folate intake, one possible strategy in the U.S. is to fortify corn masa flour with folic acid, as is done with other cereal grains.

Nationally, the reduction in NTDs has been observed for all race/ethnic groups. However, NTDs still occur at higher rates for Hispanic women. Possible reasons for this could include lower folic acid use and genetic factors that prevent the body breaking down and using folic acid, according to this CDC MMWR.

Additionally, non-Hispanic American Indian mothers reported the lowest consumption of  daily folic acid (18%) during the month before pregnancy of any racial/ethnic group. Culturally sensitive, targeted education could help increase folic acid intake.

WIC participants have low folic acid use

The Women Infant and Children (WIC) Supplemental Nutrition Program serves lower-income pregnant, breastfeeding, and postpartum women and children under age five. While 40% of MN PRAMS respondents reported participating in WIC during their pregnancy, only 20% took folic acid daily in the month before they became pregnant.

Folic acid use is related to education and poverty

The percent of mothers that take folic acid daily during the month before pregnancy incrementally increases with more education. Only 18% of mothers with less than a high school education reported daily folic acid use one month prior to pregnancy as compared to 51% of mothers with a college education. 

Women living in poverty were less likely to take folic acid prior to pregnancy. Mothers who were in the "poor" category (within 0-100% Federal Poverty Levels) had the lowest percentage (18%) who took folic acid daily during the month before pregnancy, as compared to mothers that were in the "not poor" category  (over 185% of the FPL) (47%).


MN PRAMS works to improve health of mothers and infants

The Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) was established in 2002 to reduce infant death, illness, and low birth weight in Minnesota. PRAMS is a population–based surveillance survey designed to collect information on the behaviors and experiences of mothers before, during, and after a pregnancy.

Data from 2009-2011 PRAMS surveys are combined to assess daily folic acid supplement use. Each month, approximately 200 mothers are selected from the birth certificates of babies born in Minnesota during the preceding 2–4 months. Mothers complete the survey by mail or by a telephone interview. One of the PRAMS questions is about folic acid supplement use ("During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin or a folic acid vitamin?").

Responses from Minnesota mothers can identify disparities in daily folic acid supplement use. Targeting mothers with low folic acid use through culturally sensitive, targeted education and increasing the availability of affordable, high-folate foods and folic acid supplements can reduce the risk of NTDs occurring.


Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), Minnesota Department of Health, Division of Community and Family Health, Maternal and Child Health This data was made possible by grant number IU01DP003117-01 from the Centers for Disease Control and Prevention