A leading cause of death and disability may now be prevented for many children. Daily consumption of 400 micrograms (0.4 mg) of folic acid by women of child bearing age may prevent spina bifida and other neural tube defects (NTDs) by 50-70 percent.⁽¹⁰⁾   In 1992 the U.S. Public Health Service recommended consumption of 400 micrograms of folic acid daily by all women of child bearing age.(11-14, 15) Folic acid represents an important public health opportunity to significantly decrease NTDs such as spina bifida the leading cause of childhood paralysis. Because not all pregnancies are planned, women of childbearing age should be encouraged to make a dietary behavior change, which includes folic acid.

Trends in rates of NTDs both across the U.S. and Florida have been declining since 1998 when mandatory folic acid fortification of all enriched grain products was implemented in the United States. This downward trend is presented in Figure 53. While U.S. and Florida data are not comparable due to differences in case ascertainment methodology, active surveillance to identify affected pregnancies is essential to educating women and their health care providers about the important role folic acid plays in preventing birth defects. An increased risk for Hispanic children born out-of-state is noted in Figure 54.^{(16, 17)}

Figure 53: Trends in Spina Bifida and Anencephalus in the U.S. (1991-2001) and Florida (1996-1999)

Source: U.S. Data – National Vital Statistics System, NCHS, CDC. National Center for Health Statistics; www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm (excludes data from Maryland, New Mexico and New York. Source: Florida Data - Florida Department of Health, Florida Birth Defects Registry (FBDR) http://fbdr.hsc.usf.edu *Provisional

Figure 54: Florida Neural Tube Defects by Hispanic Origin and Maternal Place of Birth, 1997-99 Source: Florida Department of Health, Florida Birth Defects Registry, Bureau of Environmental Epidemiology and the Birth Defects Consortium

For all Hispanic groups, the Neural Tube Defect rate for foreign-born Hispanic women was significantly higher than for Hispanic women born in the U.S.

Source: March of Dimes Folic Acid Surveys: Nationally representative telephone surveys conducted by the Gallup Organization targeting English speaking women ages 18-45) ( http://www.peristats.modmes.org/folicacid.cfm)

Figure 55: Trends in U.S. Women Who Take a Folic Acid Supplement Daily, Know It Prevents Birth Defects and Know it Should be Taken Prior to Pregnancy