Folic acid

In North Carolina, about 200 pregnancies per year are affected by a neural tube defect (NTD). More than half of these babies will never be born. The others may be born with some degree of disability ranging from mild to severe. In some cases, the disability causes the baby to be stillborn or die within days after birth. If all women in the U.S. consumed adequate amounts of folic acid throughout their childbearing years, the incidence of NTDs could be reduced by up to 70 percent. Recent studies show that periconceptional multivitamin use may also reduce the risk of other major birth defects, such as orofacial clefts, congenital heart defects and urinary defects. In addition, some studies show that folic acid may help reduce the risk for heart disease, stroke and colon cancer. 

“One of the most exciting medical findings of the last part of the 20th century is that folic acid, a simple, widely available, water-soluble vitamin, can prevent spina bifida and anencephaly. Not since the rubella vaccine became available 30 years ago have we had a comparable opportunity for primary prevention of such common and serious birth defects.” – G. Oakley, MD, JAMA, March 10, 1993 

The North Carolina Preconception Health Campaign has found that encouraging women to take a multivitamin instead of a folic acid pill is more effective in producing a behavior change. Focus group testing in North Carolina revealed that young women are not interested in hearing about pregnancy, NTDs or folic acid unless they are actively contemplating a pregnancy. They are interested, however, in discussing weight, diet, nutrition, energy, exercise and their body in general terms. They state that they take multivitamins for non-pregnancy-related health issues and that they are unlikely to take a folic acid pill alone. These sentiments are reflected in our materials and on other sections of this website.

As a health professional, you are an important motivator to change patient behavior. Studies have shown that a simple recommendation from a health professional is a major reason why women take supplements. According to a study conducted by the Gallup Organization and March of Dimes Foundation, almost 90 percent of women say they’d take multivitamins at their doctor’s recommendation. Additionally, 99 percent of Latina women surveyed in North Carolina stated they would take a multivitamin if their health care provider recommended it. However, only 33 percent of women ages 18-45 who say they are aware of folic acid actually heard about folic acid from their health care provider.1

Patients value the opinion of their health care provider. Tell your patients, even those not planning a pregnancy, to take a multivitamin with folic acid daily. The North Carolina Preconception Health Campaign provides free in-service presentations to health care providers in North Carolina. For more information about our folic acid trainings, please contact us

A provider training on folic acid is also available from the NC Department of Public Health. Click here to download the slides.


  1. Gallup Organization and March of Dimes Foundation (2008). Improving Preconception Health: Women’s Knowledge and Use of Folic Acid.

  2. PRAMS, 2005. PRAMS is an ongoing, population-based, randomized survey of North Carolina resident women who have recently given birth. Information is collected on pregnancy risk factors, access to health care services and other issues related to improving the health of both the mother and the baby. It is conducted by the NC State Center for Health Statistics.

  3. BRFSS, 2006. BRFSS is an ongoing, population-based, randomized survey of state residents aged 18 and older in households with telephones. Information is collected on a variety of health behaviors and preventive health practices related to the leading causes of death and disability such as cardiovascular disease, cancer, diabetes and injuries. It is conducted by the NC State Center for Health Statistics.

  4. PRAMS, 2005

  5. BRFSS, 2008

  6. Gallup Organization and March of Dimes Foundation (2008). Improving Preconception Health: Women’s Knowledge and Use of Folic Acid.

  7. Ibid.

Revised: June 6, 2011

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