Folic Acid Supplements Still Advised
WebMD News Archive
"Women should be cautioned that half of all pregnancies are unplanned
and that folic acid must be taken before conception to be effective. Taking
supplements is the safest and most effective way" to prevent the birth
defects associated with folic acid deficiency," he concludes.
Mills tells WebMD he wrote the article because "there has been a lot of
politicking to increase the amount [of folic acid]" in enriched flour. The
dose for most women who could become pregnant is 400 mcg per day, and 4,000 mcg
per day is recommended for women who have already had a child with a birth
defect associated with low folic acid, Mills says.
The results of the current folic acid enrichment program are not expected to
be available until sometime later this summer, says J. David Erickson, PhD,
chief of the branch of birth defects and genetic diseases at the CDC.
"Our best guess at this was that you might see a 50% drop [in these
birth defects]," Erickson says. "That would be our hope; that's what
one would hope to achieve with fortification. The projections by the FDA at the
time were that women would consume an extra 100 mcg a day [with fortification].
That is one-fourth the recommended amount."
Mills provoked an impassioned response from Godfrey Oakley, MD, who likened
Mills' article to "yelling fire in a crowd." Until two years ago,
Oakley was the director of the CDC's Division of Birth Defects and
"My view is that, from everything we know up this point, the amount of
fortification is not enough," Oakley tells WebMD. "You would have to
eat a loaf of bread" made with folic acid-fortified or enriched flour to
reach the recommended level, says Oakley. He is currently a visiting professor
of epidemiology at Emory University in Atlanta.
"What gets missed is [that] this is not about what is the dose at which
you can start to see some protective effect," he says. "That is not
what you are after. It is about what is the least dose that will give you the
most protective effect. It takes 400 mcg to do the whole job. We should have no
child with folic acid-preventable [birth] defects. I agree that until
fortification is fixed, we need to be teaching as many women as we can ... to
take a multivitamin." However, this is an ineffective solution, he notes,
because "no more than 50% of women will take vitamin supplements."