Folate deficiency still seen in US minorities

By Will Boggs, MD

NEW YORK (Reuters Health) - Racial and ethnic differences in blood levels of folate persist despite the fortification of food with folic acid in the US, according to a new report.

"Even after the US cereals and grains were fortified with folic acid in 1998, women in racial and ethnic minority groups had lower serum folate levels than women who were non-Hispanic whites," Dr. Jean M. Lawrence from Kaiser Permanente Southern California, Pasadena, told Reuters Health.

"Our study results suggest that Latina, black or Pacific Islander women, as well as women who are overweight and obese, may be particularly at risk of having lower folate levels," she added.

Lawrence and here colleagues used data from the Kaiser Permanente Medical Care Program to investigate whether folate values varied by race, ethnicity, body mass index, and maternal age among 9421 pregnant women who started prenatal care.

Folate levels were the highest among women who consistently used vitamins and were progressively lower among women who had just started taking vitamins, were former vitamin users or did not take vitamins, the investigators report in the American Journal of Obstetrics & Gynecology.

Women who were underweight or normal weight had the highest average folate levels, the researchers note, and values were lower for overweight women and lowest for obese women.

Folate deficiency is linked to an increased risk of having a baby with a neural tube defect like spina bifida. "While it is very important for women to take prenatal vitamins when they are pregnant, the point of this study is to identify groups of women who may be at risk for neural tube defects because they are not taking folic acid when they become pregnant," Lawrence said.

"In our study, only 35 percent of the women reported that they were taking vitamins when they learned they were pregnant, while 25 percent of the women started taking vitamins when they learned they were pregnant," she commented.

How much folic acid should a woman of childbearing age take? "Until the optimal folate level is identified that confers maximum protection against neural tube defects," Lawrence advised, "health care professionals and women's health advocates should continue to encourage women who can become pregnant to take a vitamin containing 400 micrograms of folic acid every day."

SOURCE: American Journal of Obstetrics & Gynecology, February 2006.