AYUMI NAKANISHI / ANAKANISHI@STARBULLETIN.COM Takako Nakaaki looked over literature last Thursday at the Global Public Health Conference at the Hawaii Convention Center.

Baby’s health
starts with B

A B-vitamin in rice and cereals
effectively prevents many dire
conditions, including birth defects

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By Helen Altonn
haltonn@starbulletin.com

RICE has unexpected benefits for women of childbearing age, and fortified breakfast cereals are even better.

These are among food sources of folic acid, a B-vitamin that is critical to protect unborn babies from neural tube defects.

Folic acid also can help to reduce incidence of stroke and heart attack, and it has an effect on colon and cervical cancer, says Connie Brunn, program services director for the March of Dimes Hawaii Chapter.

The nonprofit organization has been leading a national campaign since 1998 to educate women of childbearing age (18 to 45) and physicians about the importance of folic acid. Collaborating are the Centers for Disease Control and National Council on Folic Acid.

The CDC and U.S. Public Health Service have for 10 years recommended daily consumption of 400 micrograms of folic acid before conception and in early months of pregnancy.

Takako Nakaaki, with the state Health Department's STD-AIDS Prevention Branch on Maui, takes a prenatal vitamin to supplement fortified foods.

"Mainly, I focus on cereal; it's easier to take," said Nakaaki, expecting her second child in August. "I check the box (of nutrition facts) to get not just folic acid, but nutrients."

But Nakaaki is one of only about 26 percent of Hawaii women of childbearing age who take folic acid vitamins daily, according to a recent Gallup Organization survey.

The national survey of 2,004 women ages 18 to 45, conducted earlier this year for March of Dimes, shows nearly 70 percent of American women of childbearing age fail to take folic acid every day although 80 percent are aware of it.

About 58 percent of Hawaii women of childbearing age are aware of folic acid, according to the survey.

Brunn said the national rate of births with neural tube defects dropped 19 percent between 1996 and 1999 after the FDA in 1998 required grain foods to be fortified with folic acid.

While that is encouraging, the rate of neural tube defects still is too high, she said.

In Hawaii, birth defects occurred in 8.3 percent of the total 18,067 births in 1999, varying little from the 8.1 percent rate in 1986, according to the Hawaii Birth Defects Program.

"Our rates of neural tube defects in Hawaii are fairly low," Brunn noted. "Rice seems to be fairly high in folic acid, and everybody out here eats rice."

In a research update on folic acid and neural tube defects, Amy Brown, University of Hawaii-Manoa professor in the Department of Human Nutrition, Food and Animal Sciences, reports:

>> About 2,500 to 3,000 babies are born annually in the United States with neural tube defects, and many pregnancies result in miscarriage or stillbirth due to such defects.

>> About half the cases involve genetic factors; the other half would benefit from folic acid.

>> About 66 percent of neural tube defects are spina bifida, where the spinal cord forms outside the backbone; 34 percent are anencephaly, a fatal condition in which the brain is partially or completely missing.

>> Medical care and surgical costs for spina bifida exceed $200 million.

>> The CDC estimates 50 to 70 percent of neural tube defects could be prevented if women followed folic acid recommendations.

Even if cases are reduced to two or three a year, that is too many, Brown said. "It makes a 100 percent difference to that one person. Basically, they don't have a completed spinal cord or brain."

She said any woman who could become pregnant should take folic acid daily because almost half of pregnancies are unplanned. A woman may not know she is pregnant in the first three months, and the first trimester is the most crucial time in terms of birth defects, she said.

"That's when cells are dividing, with the highest impact for having a birth defect," Brown said. "That's true with fetal alcohol syndrome. That's also true with neural tube defects." The Hawaii Women, Infants and Children Services Branch, which serves about 8,200 postpartum women a month, has developed informational brochures on folic acid, including sample menus.

But WIC Director Linda Chock stressed that women need to take folic acid before they get pregnant. "All we can hope for is to educate them for the next pregnancy."

The March of Dimes Hawaii Chapter has organized a Folic Acid Council, being coordinated by the Healthy Mothers Healthy Babies Coalition, to push folic acid education. It also has awarded grants to the Primary Care Association to provide folic acid resource kits to health care providers and to the Community Clinic of Maui to supply prenatal vitamins with folic acid to patients.

For more information, visit www.marchofdimes.com or call 888-MODIMES (toll-free).

High acid >> Dry beans >> Strawberries >> Romaine lettuce >> Orange juice >> Pineapple juice >> Spinach >> Fortified breakfast cereals Medium acid >> Corn >> Peanut butter >> Green peas >> Broccoli >> Rice >> Mangos >> Avocados Source: Amy C. Brown, University of Hawaii-Manoa Department of Human Nutrition, Food & Animal Sciences