Women of reproductive age should take vitamin until grain product is enriched  

Women of reproductive age in the U.S. who regularly consume corn masa flour products, such as corn tortillas, may have a folate deficiency.

The Food Fortification Initiative based at the Emory University Rollins School of Public Health, recently conducted a nationwide survey using a social media campaign (#FindFolicAcid) to evaluate the impact of a 2016 U.S. Food and Drug Administration guideline recommending voluntary fortification of corn masa flour and tortillas with folic acid (vitamin B9). Their findings from 28 states included 43 unique corn masa flour or corn tortilla products, and confirmed the results from an earlier Rollins study in Atlanta: Most corn masa flour and tortilla manufacturers were ignoring the recommendation. Only three masa flour products included folic acid, and none of the corn tortillas were fortified.

Folic acid (vitamin B9) taken before and during pregnancy has long been proven to prevent spina bifida and anencephaly, birth defects of the brain and spinal cord that can be fatal and cause severe physical disabilities.   

The Centers for Disease Control and Prevention (CDC) recommends all women of reproductive age take 400 micrograms of folic acid each day. Corn masa flour is not required to be fortified with folic acid by the Food and Drug Administration, unlike other enriched grain products.  

The social media campaign results were published last week in Birth Defects Research, compiled by Vijaya Kancherla, PhD, along with Hallie Averbach, MPH, and Godfrey P. Oakley, MD, MSPM. 

Kancherla and Oakley, from the Center for Spina Bifida Prevention at Rollins, were involved in the earlier Rollins study, which assessed the extent of folic acid fortification in corn masa and corn tortilla products in Atlanta grocery stores.

Adding folic acid to other grain products has prevented around 1,300 birth defects of the brain and spine annually in the U.S.; grain products labeled “enriched” must contain folic acid to stay compliant with an FDA regulation passed in 1996, but this does not currently apply to corn masa flour. 

“Voluntary fortification of corn masa flour is not working,” says Oakley. “There is an urgent need especially for Hispanic women of reproductive age to consume a multivitamin with the recommended dosage of folic acid daily, and for producers of corn masa flour, corn tortillas and tortilla chips to urgently fortify all their products with the vitamin.”

Hispanic women in the U.S. (many of whom traditionally cook with or eat products made out of corn masa flour) are 21 percent more likely than others to have a baby with a brain or spinal birth defect, which develop early in pregnancy.

Babies born with anencephaly are missing parts of their brain and skull, and almost all of them will die shortly after birth. Spinal birth defects such as spina bifida have varying degrees of severity that can lead to early death or lifelong disability. The CDC’s recommended intake of folic acid daily before conception and within 28 days after conception prevents most of these birth defects.