1. Healthy Before Pregnancy March of Dimes NC Preconception Health Campaign

2. Multivitamins: Take them for life Lesson Plan 2

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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 time? Source: http://www.visembryo.com/baby/stage1.html

9. Answer:

10. Spina bifida Photo source: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention

11. Spina bifida diagnosis Disabilities may include: Paralyzed legs Loss of bowel control Loss of bladder control Learning disabilities

12. 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 20 years ago. Source: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention

13. 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

14. Anencephaly Prognosis Miscarriage (spontaneous loss) Stillbirth Neonatal death

16. 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

17. Prevalence of neural tube defects by type North Carolina, 1998-2008 (excl. TABs < 20 weeks)

18. 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

19. 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

20. Take a multivitamin every day Two-thirds of U.S. women do not consume enough folic acid and/or folate!

21. 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!

22. 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.

23. 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)

24. 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

25. Some cereals that contain 100% of the daily value of folic acid For a complete list go to www.cdc.gov/ncbddd/folicacid/cereals.htmlwww.cdc.gov/ncbddd/folicacid/cereals.html 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.

26. 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

27. Multivitamins! For illustrative purposes only. The March of Dimes does not endorse or recommend any brand, manufacturer or type of multivitamin or supplement.

28. 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.

29. Other important research may benefit adults Studies show that folic acid may reduce: -Cardiovascular disease -Alzheimer's -Cervical cancer -Colon cancer -Stroke