News Moms Need

You’ve heard a lot about the importance of folic acid. Recently, a pregnant woman wrote to us and asked exactly what she would need to eat in order to get all her folic acid needs from food instead of a vitamin. Good question…complicated answer.

The first thing you need to know is that the natural form of folic acid is called folate. Folate is found in lentils, spinach, black beans, peanuts, oranges and orange juice, legumes, romaine lettuce, leafy green veggies and broccoli. But, you have to eat a lot of these foods to get the right amount of folic acid (400 mcg per day). Cooking and storage can destroy folate, so even if you have the best intentions, your plans may be foiled. To make matters worse, according to the Institute of Medicine (IOM), your body only absorbs about 50 % of folate from food. Not much!

Fortunately, there is a way around having to eat tons of lentils and broccoli every day. The manufactured or synthetic form of folate is called folic acid. Many grain products in the United States are fortified with folic acid (meaning folic acid is added to them). The best part of this is that your body actually absorbs folic acid better than it absorbs folate. In fact, your body absorbs approximately 85% percent of the folic acid in fortified foods and 100% of the folic acid in a vitamin supplement. (I like these numbers a lot more!) That is a whole lot more than only 50% your body absorbs from foods with folate.

So where can you find these fortified foods? Enriched is the magic word. Enriched flour, rice, pasta, bread and cereals are examples of fortified grain products. You can check the label to see if a product is enriched and to see how much folic acid each serving contains.

Here’s even better news…Many studies have shown that the synthetic form of folic acid helps prevent NTDs (neural tube defects) – a kind of birth defect. This is why the IOM, the Centers for Disease Control and Prevention (CDC) and the March of Dimes recommend that all women of childbearing age consume at least 400 micrograms a day of the synthetic form of folic acid.

A simple solution…

You can eat a serving of fortified cereal that contains 100% of the daily value of folic acid every day. Or…(drumroll please…) you can pop a vitamin. Of course, a healthy diet is very important, but taking a daily multivitamin that contains at least 400 mcg of folic acid (or at least 600 mcg if you are pregnant) is key in ensuring that you are getting and absorbing the folic acid that your body needs – whether you are planning on getting pregnant or not. It really couldn’t be easier.

You may have read or heard on the news lately that a couple of recent studies are showing concerns about the health benefits of taking vitamins and supplements. While some vitamins may be questionable, folic acid is very important for all women of childbearing age. It helps to protect developing babies from certain birth defects. So keep taking it.

According to a couple of these new studies, vitamins may not be as beneficial as previously thought. The research suggests that in some instances some vitamins may be harmful as we get older. One study of older women suggests that taking vitamin supplements, including folic acid, may slightly increase a woman’s risk of death after the age of 62. Another study of men states that taking vitamin E supplements may significantly increase the risk of prostate cancer.    HOWEVER, these are single studies and much more research needs to be done before we know how accurate these results may be. 

Here is what we do know now. Research has repeatedly demonstrated that all women of childbearing age should take 400 micrograms of folic acid before getting pregnant to help prevent neural tube defects (serious birth defects of the brain and spine). This is especially important since about half of all pregnancies are unplanned. During pregnancy, women should get at least 600 micrograms of folic acid.

If you have any questions about taking vitamins, talk with your health care provider.

Of the four million women who give birth in the US each year, some 3,000 babies are born with neural tube defects, which include certain birth defects of the brain and spinal cord. Folic acid is a critical element needed for proper spinal cord development during the first three weeks of pregnancy. Because this is often before a woman even knows she’s pregnant, it’s important for women of child-bearing age to follow a healthy lifestyle and to include folic acid as part of their diet.

The Grain Foods Foundation has joined with the March of Dimes to remind all women of child-bearing age of the important role folic acid plays in preventing birth defects. Enriched breads – and many other grains such as rice, tortillas, pasta and cereal – are important sources of folic acid. 

• White flour is enriched with three major B vitamins (niacin, thiamin and riboflavin), as well as iron, and is fortified with the B vitamin folic acid.
• Enriched flour contains two times as much folic acid as its whole grain counterpart – making enriched grains the largest source of folic acid in the diets of most Americans. Whole grain products, with the exception of some breakfast cereals, are not fortified with folic acid.
• Since the FDA required fortification of enriched grains, the number of babies born in the U.S. with neural-tube birth defects has declined by 34 percent in non-Hispanic whites, and by 36 percent among Hispanics.

Grain foods are a delicious and nutrient-dense component of a healthy diet and have been shown to help with weight maintenance. In fact, people who consume a medium-to-high percentage of carbohydrates in their diet have a reduced risk for obesity. This is important for women of childbearing age as obese women who are pregnant have a significantly higher risk of needing a Cesarean section delivery, delivering too early, developing pre-eclampsia, and having an exceptionally large baby. They also face double the risk of stillbirth and neonatal death.

For a balanced diet, the USDA recommends at least six one-ounce servings of grains daily. Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal and even tortillas and pretzels are examples of grain foods.

This is so great!  What a delicious surprise!

For those of you who are pregnant, sometime between 15-20 weeks of pregnancy, you will be offered maternal serum screening.  What is this?  And more importantly, what do the results mean?  I think maternal blood screening is one of the most misunderstood tests in pregnancy.  And for some women it can be a very nerve-wracking experience. 

The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women regardless of age be offered a screening test for Down syndrome and certain other birth defects.  This is a blood test that looks at the levels of either 3 or 4 (depending on the test) chemicals that are present in a pregnant woman’s blood.  The chemicals are AFP (alpha fetoprotein), hCG (human chorionic gonadotropin—the same chemical that a home pregnancy test measures), estriol, and recently most labs have added a fourth substance, inhibin A.  These chemicals are present in every pregnant woman’s blood.  Some of them are produced by the fetus while others are hormones produced by the placenta. 

Maternal serum tests such as the triple screen or the quad screen as they are commonly called, look at the levels of these 3 or 4 chemicals in the mother’s blood and the woman’s age, weight, race, number of fetuses (e.g. twins) and whether she has diabetes that requires insulin treatment.  Then given all of those factors and the levels of the 3 or 4 chemicals the laboratory can determine the chance that a woman has a baby with Down syndrome, a neural tube defect (spina bifida), trisomy 18, or abdominal wall defects.

There are two different ways that the results may be reported.  A woman may receive her test result as a ratio. For example, her baby has a 1 in 500 chance for Down syndrome. Or, in some cases, a woman’s test results are reported as normal (screen negative) or abnormal (screen positive), depending on whether her results fall below or above a cut-off point (usually about 1 in 270).

The test is NOT a diagnosis of any of these conditions though.  This is where there is a lot of confusion.  By definition, screening tests do not diagnose a condition.  They only determine whether there is an increased risk for the condition.  The good news is that of all of the women who screen positive, only a small percentage will actually have a baby with one of these disorders.  Many times women have an abnormal result simply because their fetus is a few weeks older or younger than previously thought.  

For women with abnormal results, the next step is usually an ultrasound. This test can check the gestational age of the fetus and show if a woman is carrying multiples. If either of these factors accounts for the abnormal test result, no further testing is needed. If ultrasound does not explain the abnormal test result, amniocentesis will be offered.  An amniocentesis is an invasive test where the doctor uses a needle to remove some of the amniotic fluid around the baby.  Although amnio does pose a very slight risk of miscarriage (1/4 of one percent or 1/500), it is extremely accurate and usually can give a pregnant woman a definitive answer.  Should a problem exist, arrangements can be made in advance for special care of the newborn at delivery.

Not enough American women understand that consuming the B vitamin folic acid every day can help prevent serious birth defects and that they should take it before they become pregnant. Did you? 

Studies show that if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all birth defects of the brain and spine known as neural tube defects (NTDs), such as spina bifida, could be prevented.  The most recent March of Dimes survey revealed that only 28 percent of women of childbearing age knew folic acid can prevent birth defects and only 11 said they knew that folic acid should be consumed prior to pregnancy.  Wow, those are really low numbers for something so important!

This January, as part of National Birth Defects Prevention Month, we’re trying to remind all women of child-bearing age of this really important role folic acid plays in preventing birth defects. Daily consumption of the B vitamin folic acid beginning before pregnancy is crucial because NTDs can occur in the early weeks following conception, often before a woman knows she is pregnant. 

We urge all women of childbearing age to consume 400 micrograms of folic acid daily.  Bread, crackers, bagels, pasta, pretzels and tortillas made from fortified, enriched white flour are popular and important sources of folic acid.  In fact, enriched grain products have been fortified with twice the amount of folic acid found in whole grain products. Other good sources are leafy green veggies like spinach and kale, dried beans, legumes, oranges and orange juice.  And you’ll find it in a daily multivitamin, too. 

Taking folic acid as part of your daily routine before, during and after pregnancy is a great New Year’s resolution!

You may have seen recent news coverage about a study showing that daily multivitamins may not help prevent cancer or heart disease. But that doesn’t mean you should stop taking your multivitamins. That’s because most multivitamins have folic acid, and folic acid is known to help prevent birth defects of the brain and spinal cord when taken before the end of early pregnancy. The trouble is that most women may not even know they’re pregnant at the time when folic acid is most beneficial at preventing birth defects. That’s why it’s important that women take multivitamins before getting pregnant.

When shopping for a multivitamin, make sure it has at least 400 micrograms of folic acid. Once you know you’re pregnant, your health provider will give you prenatal vitamins, which have the amount of folic acid you need.

Chef Rock

Chef Rahman “Rock” Harper, winner of Fox Television’s 2007 Hell’s Kitchen, knows the importance of a healthy pregnancy.  Touched by the effects of preterm delivery and birth defects in his own children, he is now a celebrity chef for the March of Dimes Signature Chef Auctions.

Aware of the importance of taking folic acid to prevent neural tube defects, Chef Rock has created the following “folic friendly” recipe for us and it sounds delicious!  I can’t wait to make this.  Enjoy!

Crispy Sautéed Branzino with “rice and peas” and savory spinach
Rice and peas:
8 ounces dried kidney beans, rinsed and picked over (about 1 1/4 cups)
3 cloves garlic, peeled and smashed
6 cups cold water
1 (14-ounce) can coconut milk
4 large sprigs fresh thyme
3 scallions, ends trimmed, smashed with the side of a knife
1 tablespoon olive oil
1 tablespoon kosher salt
1 whole Scotch bonnet pepper, pierced with a paring knife
3 cups enriched long-grain rice
In large saucepan, combine beans with garlic and water. Bring to boil, reduce to simmer, cover pot and continue to cook until beans
begin to soften, about 30 minutes. Add coconut milk and thyme and continue cooking until the beans are soft, 45 minutes to 1 hour
longer. Add scallions, oil, salt, Scotch bonnet, and stir to combine. Cover and let sit until scallion has softened, 2 to 3 minutes.
Return liquid to boil and add rice. Stir to combine well and return to a boil. Stir again, cover pot, reduce heat to low and cook,
stirring once after about 5 minutes, until rice has absorbed the liquid and is tender, 25 to 30 minutes. Remove from heat and let sit
undisturbed for 10 minutes. Remove pepper, scallions, and thyme sprigs, fluff with a fork, and serve. 
Branzino:
2 tablespoons olive oil
8 (6-ounce) portions skin-on black bass
1 teaspoon salt
1/2 teaspoon fresh ground white pepper
Flour for dredging
Set a 12-inch saute pan over medium-high heat. Add olive oil. Use a sharp knife to score the skin of the fish with 2 or 3 diagonal
slits piercing the skin only. Season fish with salt and pepper and dip in flour. Shake off excess flour and place fish, skin side down,
in pan. Cook until fish begins to caramelize, about 3 minutes. Turn fish over and cook 2 minutes.
Spinach:
1 1/2 pounds spinach leaves-washed and picked free of stems
2 tablespoons olive oil
1 tablespoon chopped garlic (3 cloves)
1 tablespoon chopped shallot 1 shallot
2 teaspoons kosher salt
1/2 teaspoon freshly ground black pepper Lemon
In a very large pot, heat olive oil and saute garlic and shallots over medium heat for about 1 minute, but not until browned. Add
spinach, salt, and pepper to pot, toss with garlic and oil, cover pot and cook for 2 minutes. Uncover pot, turn heat on high, and cook
spinach for another minute, stirring with a wooden spoon until all the spinach is wilted. Using a slotted spoon, lift spinach to a
serving bowl and top with a squeeze of lemon and sprinkling of kosher salt. Serve hot.