Healthy Before Pregnancy

March of Dimes
NC Preconception Health
Campaign
 Multivitamins:
Take them for life
Lesson Plan 2
 Birth defects: The big
picture
• 1 in 33 U.S. babies is born with birth
defects (120,000)
• Most common include:
• Heart defects
• Cleft lip/palate
• Down syndrome
• Spina bifida (neural tube defect)
 Birth defects that can be
prevented
• Neural tube
defects (NTDs)
• Spina bifida
• Anencephaly

Source: National Center on Birth Defects and

Developmental Disabilities, Centers for Disease
Control and Prevention
 How do NTDs occur?
• The brain and spine start as a tiny
pancake of tissue
• It folds inward and makes a tube
• Around 28 days after conception the
tube “zips” up
• If the tube does not close completely
a hole is left and an NTD is formed
 Neural tube defects
• Approximately 200 pregnancies are
affected by an NTD each year in
North Carolina
• 2,500-3,000 U.S. babies are born
each year with an NTD
• Another 1,500 are still born,
spontaneously miscarried or
terminated
 Main message
• If all women consumed the
recommended amount of folic acid
before and during early pregnancy,
up to 70 percent of all NTDs could be
prevented
• The U.S. Public Health Service
recommends that ALL women of child-
bearing years take 400 micrograms
(mcg) of folic acid every day
 Spina bifida
• Spina bifida
occurs when the
lower end of the
developing neural
tube fails to close
(just 23-28 days
after conception).
• What is the size of
the embryo at this
Source: http://www.visembryo.com/baby/stage1.html time?
Answer:
 Spina bifida

Photo source: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and
Prevention
 Spina bifida diagnosis
• Disabilities may include:
• Paralyzed legs
• Loss of bowel control
• Loss of bladder control
• Learning disabilities
 Quality of life
• 80-90 percent of
infants who are born
with spina bifida will
live.
• Thanks to
advancements in
treatment and
prevention, those born
with this challenging
birth defect are living
longer, more
productive lives than
was dreamed of just
Source: National Center on Birth Defects and 20 years ago. 
Developmental Disabilities, Centers for
Disease Control and Prevention
 Anencephaly
• Anencephaly is a
fatal condition in
which the upper
end of the neural
tube fails to close.
• The brain either
never completely
develops or is
totally absent.
Source: National Center on Birth Defects and
Developmental Disabilities, Centers for Disease
Control and Prevention
 Anencephaly
• Prognosis
• Miscarriage
(spontaneous
loss)
• Stillbirth
• Neonatal death
 Who’s at risk?
• All women capable
of becoming
pregnant are at
risk of having a
baby with an NTD
BUT…
• Latina women are
at a much higher
risk
Prevalence of neural tube defects
by type
North Carolina, 1998-2008 (excl. TABs < 20 weeks)
 Other birth defects
• Folic acid may also
protect against:
• Development of
infant heart defects
• Cleft lip
with/without cleft
palate

Photo source: National Center on Birth Defects and

Developmental Disabilities, Centers for Disease
Control and Prevention
 Prevention:
It’s all about timing
• The U.S. Public Health Service
recommends that all females who
have started menstruation take a
daily multivitamin with 400 mcg of
folic acid
• If all women consumed the 400 mcg
of folic acid before and during early
pregnancy, up to 70 percent of all
NTDs could be prevented
Take a multivitamin
every day
• Two-thirds of
U.S. women
do not
consume
enough folic
acid and/or
folate!
 How can you get enough folic
acid?
1. Food (folate)
• Leafy green
vegetables,
orange juice,
beans
2. Fortified food
(folic acid)
• Cereals, breads,
nutrition bars
3. Multivitamins!
Folate
• Folate is an essential
nutrient that humans
cannot easily
synthesize and is
found naturally in
foods.
• Absorption depends
on the food itself,
how it is cooked, and
individual’s ability to
metabolize folate.
 Fit folic acid into your life!
• Taking a pill is
better than eating
a vitamin in its
natural food form
• Folic acid is most
absorbable in a
multivitamin or
supplement
(compared to folate
found in foods)
The FDA takes action: 1996
• Ordered “enrichment”
of all flour or grain
products, 140 mcg per
100g of grain product
• Approved the use of
health claims on
products that contain
significant amounts of
folic acid
• However, these efforts
have proven to be
insufficient for full
prevention of birth
defects
Some cereals that contain 100% of
the daily value of folic acid
• General Mills
Harmony
• Total
• Product 19
• Quaker Oats
Cinnamon Crunch
• Cheerios Plus
• Smart Start
For informational purposes only. The March of
Dimes does not endorse or recommend any
brand, manufacturer or type of cereal
product.
For a complete list go to www.cdc.gov/ncbddd/folicacid/cereals.html
 Multivitamins:
So what’s in it for me?
• Fills in the nutrition
gaps
• Some studies suggest
that folic acid has
other benefits
• May protect against
heart disease, stroke
and certain cancers
• May protect against
other birth and heart
defects
 Multivitamins!

For illustrative purposes only. The March of Dimes does not endorse or recommend
any brand, manufacturer or type of multivitamin or supplement.
Tips on taking multivitamins
• Combine taking a multivitamin with another
everyday activity, such as brushing your
teeth.
• Place your bottle of multivitamins where
you’re likely to see it.
• Try chewable multivitamins if you have
trouble swallowing regular multivitamins.
• Try taking a multivitamin with food or at
night if it upsets your stomach.
• Buy generic multivitamins: They can be as
effective as name brands and often cost less.
• Check the expiration date on the bottle.
Other important research may
benefit adults
• Studies show that
folic acid may
reduce:
- Cardiovascular
disease
- Alzheimer's
- Cervical cancer
- Colon cancer
- Stroke