FDA ruling on folic acid could reduce anencephaly

RICHLAND, Wash. – A Washington State University nursing instructor says the recent announcement from the U.S. Food and Drug Administration allowing folic acid to be fortified in corn-masa flour may help reduce the number of infants born without brains.

Sara Barron, a nurse and WSU Tri-Cities nursing instructor, said folic acid was proven to reduce the risk of spine and brain defects in babies in the 1980s.  Starting in 1998, the FDA required that most grains be fortified with the supplement in order to provide American women with the amount needed to start a healthy pregnancy. This fortification dropped the rate of anencephaly in the United States from a rate of 4.2 per 10,000 live births to 2.1.

Sara Barron - anencephaly - web friendly-2
Sara Barron

Only enriching wheat products, however, hasn’t been enough, Barron said.  Following criticism in recent years about the absence of the nutritional supplement in corn masa flour, the FDA announced Thursday that it would begin adding the substance to corn masa flour beginning Friday.

Barron, who also serves on a state advisory committee for the condition, said rates for anencephaly have shown to be higher in Hispanic communities where the grain portion of their diet often consists of corn masa-based products such as corn tortillas. Until now, those products were not fortified with folic acid.

In 2012, Barron spotted a cluster of babies born with anencephaly, a birth defect where the baby is born without a brain, in Benton, Franklin and Yakima counties in Washington state. In an article published last month in the American Journal of Nursing titled “Anencephaly: An Ongoing Investigation in Washington State,” Barron highlights her personal experience discovering the cluster, in addition to exploring the possible causes of the defect and what people can do to reduce the risk of having a baby with the condition.

She said the easiest way of reducing the risk for having a baby with anencephaly is to ensure all women of childbearing age are getting at least the recommended 400 micrograms of folic acid daily prior to and during their pregnancy. The ruling of the FDA allowing corn masa fortification will help to ensure women who eat more corn will have the same advantange as women eating wheat-based grains and cereals, she said.

“You need to have a good supply of folic acid on board before you get pregnant,” she said. “By the time you find out you’re pregnant, see your doctor and start prenatal vitamins, the neural tube, which houses the brain and spinal cord, is already formed.”

Barron’s work is in line with WSU’s efforts to meet the world’s Grand Challenges, focusing specifically on preventing the onset and progression of disease while promoting healthy communities.

Risks of anencephaly

Benton, Franklin and Yakima counties have reported anencephaly cases at rates of 10.8 per 10,000 in 2012, 11.1 in 2013, 9.5 in 2014 and 6 in 2015. The rates are significantly higher than the national average of 2.1 per 10,000 live births.

In addition to a folic acid deficit and higher risks for Hispanic communtiies, other risk factors for having a baby with anencephaly include:

  • Living within one-fourth of a mile of cultivated fields
  • Genetic defect known as MTHFR, which reduces the mother’s ability to convert folic acid to the form needed for proper neural tube development in her baby
  • Obesity, diabetes and dieting as women with those conditions may not get enough exposure to folic acid through nutritional channels
  • Exposures to certain pesticides and pollutants
  • Solvents like paint thinner and industrial cleaners
  • Certain medications including valproic acid and carbamazepine and the dermatology medication isotretinoin
  • Previous neural tube defect pregnancies

Radiation exposure can also be a risk for these types of defects, however the cases in central Washington are not likely to be tied to the Hanford Nuclear Reservation as the cluster is up wind and up river from possible radiation releases, according to health department investigators.

Raising awareness about anencephaly

Barron said more research is needed to fully understand anencephaly. Her hope is that her article will encourage more health care providers to notice and report cases of the defect so researchers can learn more about it and how to prevent it.

“Washington state has what is called a passive reporting system,” Barron said. “Basically, if something unusual or a cluster of something occurs, it is on the health professional who notices to report it. The cluster in Benton, Franklin and Yakima counties had been going on for years. We probably still wouldn’t know about the cluster in had the Washington State Department of Health not been called.”

Barron said health officials should report cases of anencephaly to Lillian Bensley at the Washington Department of Health at 360-236-4248.



Sara Barron, WSU Tri-Cities nursing instructor, sara.barron@tricity.wsu.edu

Maegan Murray, WSU Tri-Cities public relations specialist, 509-372-7333, maegan.murray@tricity.wsu.edu