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Folic Acid Fortification: Initial Effects on Neural Tube Defect Prevalence in North Carolina A Report from the North Carolina Birth Defects Monitoring Program

Several observational studies have found that women who, prior to pregnancy, had supplemented their normal diets with the synthetic form of the B vitamin folic acid had a substantially reduced risk of having an infant with a neural tube defect. These findings were confirmed in 1991 in a randomized controlled trial conducted by the Medical Research Council (MRC). The MRC study demonstrated that preconceptional consumption of synthetic folic acid, in addition to the usual diet, will prevent approximately 70 percent of spina bifida and anencephaly – the two most commonly occurring NTDs. Based on these findings, in 1992 the U.S. Public Health Service published a recommendation that all women of childbearing age consume at least 400 μg of folic acid daily to reduce their risk of having a pregnancy affected by an NTD. In March 1996, the Food and Drug Administration issued a rule requiring all enriched grain products to be fortified by 1 January 1998 with 140 μg of folic acid per 100 g of cereal grain. Anecdotal information suggests that most millers in the United States were in compliance with the rule by mid-1997.