Hispanic Women at High Risk for Neural Tube Defects, May Not Have Adequate Dietary Folic Acid

By | November 4, 2018

Because folate deficiency in pregnant women has been associated with an increased risk of neural tube defects, including anencephaly and spina bifida, it is recommended that all women take folic acid supplements before and during pregnancy.  In addition, the Food and Drug Administration (FDA) has required (since 1996) the addition of folic acid to many enriched breads and cereals in order to increase the amount of folic acid in our diets.  Since this FDA recommendation was put into place, there has been about a 65% reduction in the prevalence of neural tube defects in the general population.

Earlier this year, we noted that women who adhere to low carb diets may be at risk for folate deficiency and may have an increased risk of having a child with a neural tube defect.  A new study published in JAMA suggests that other populations of women may not benefit from folic acid fortification.  While the FDA requires that all enriched cereal grains be fortified with folic acid, fortification is not required for corn masa flour, which is used to make corn tortillas and other kinds of Latin American foods.  

Researchers analyzed corn masa flour and corn tortilla products in 11 grocery stores in Atlanta area catering to Hispanic consumers. Only two of 20 corn masa flour products, and none of the 21 soft corn tortilla products, were labeled as containing folic acid.

Why is this a huge problem? Hispanic women are less likely to take prenatal vitamins containing folic acid, and they tend to have lower blood folate concentrations. While there has been a reduction in risk for neural tube defects in the United States since the institution of folic acid fortification, there is a higher prevalence of spina bifida and anencephaly in the children of Hispanic women as compared to non-Hispanic women.

The Hispanic population in the United States continues to grow steadily, and is now the single largest minority group (17.1% of the U.S. population).  Given that their diets may not contain adequate levels of folic acid, it is essential for Hispanic women to be aware of the importance of folic acid supplementation prior to becoming pregnant.

Ruta Nonacs, MD PhD

US Folic Acid Supplementation Effort May Not Be Reaching Hispanic Women (Reuters)

Availability of Corn Masa Flour and Tortillas Fortified With Folic Acid in Atlanta After National Regulations Allowing Voluntary Fortification.

Redpath B, Kancherla V, Oakley GP Jr.  JAMA. 2018 Oct 16;320(15):1600-1601.

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities.

Flores AL, Cordero AM, Dunn M, Sniezek JE, Arce MA, Crider KS, Tinker S, Pellegrini C, Carreón R, Estrada J, Struwe S, Boyle C.  Prev Med. 2018 Jan;106:26-30.

Folic Acid Education for Hispanic Women: The Promotora de Salud Model.

Flores AL, Isenburg J, Hillard CL, deRosset L, Colen L, Bush T, Mai CT.  J Womens Health (Larchmt). 2017 Feb;26(2):186-194.  Free Article

MGH Center for Women's Mental Health

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