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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

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A Cautionary Tale on Avoiding Carbohydrates and Unintended Pregnancies

By Michael McBurney

Countries such as the USA and Canada legislated folic acid fortification of flour to help prevent neural tube defects during pregnancy. Mandatory legislation was important because a baby’s brain stem and spine closes during the first trimester of pregnancy – a time when many women do not yet realize they are pregnant. After the first few months of pregnancy, it is too late to begin supplementation to protect the infant.

According to the CDC, half of pregnancies in the US are unintended. Unintended pregnancies are those which are mistimed, unplanned or unwanted at time of conception. Racial and ethnic minorities are known to experience a greater proportion of unintended pregnancies. In 2008, the incidence was 69%, 56% and 40% respectively among black, Hispanic and white women living in the US.

Based on 2006-2010 data from the National Survey of Family Growth, Kim and colleagues report unintended pregnancy rates of 63%, 48% and 42% for black, Hispanic and white women, respectively. However, racial and ethnic differences became insignificant when other variables were added to the statistical model.  Differences in unintended pregnancy between black and white women and Hispanic and white women were predominantly explained by being younger than 20y of age and non-cohabitating. Medicaid status and lower federal poverty level contributed to the difference between black and white women. Interestingly, there was a dramatic drop between Autumn 2012 (15%) and Spring 2014 (67%) in percent of women paying $0 out-of-pocket for prescription contraceptives for women with private medical insurance.

By consuming breads and other food products made with folic acid fortified flour, young women (and everyone else) will increase folic acid intake and blood folate concentrations.

By mandating folic acid fortification, the US has decreased the prevalence of neural tube defects since 1998. Governments in approximately 70 countries have adopted this same resolution. Others would be wise to follow suit.

Of course, the benefits of folic acid fortification are lost if young women avoid fortified breads and other carbohydrate sources. Don’t let your food choices guided by fad diets. Folic acid fortified carbohydrates are important, even beneficial, for the health of future generations.

Main Citation

Kim TY, Dagher RK, Chen J. Racial/ethnic differences in unintended pregnancy: Evidence from a national sample of US women. 2015 Am J Prev Med doi: 10.1016/j.amepre.2015.09.027

Other Citations

Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001-2008. 2013 Am J Prev Med doi: 10.2105/AJPH.2013.0301416

Updated estimates of Neural Tube Defects prevented by mandatory folic acid fortification – United States, 1995-2011. 2015 CDC MWWR 64(01):1-5

Smith MA, Lau C on behalf of the Teratology Society. Editorial: A resolution on folic acid fortification. 2014 Birth Defects Research Part A: Clinical and Molecular Teratology 103(1):1-2

Atta CAM, Fiest KM, Frolkis AD, Jette N, Prinsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A. Global birth prevalence of spina bifida by folic acid fortification status: A systematic review and meta-analysis. 2015 Am J Publ Health doi: 10.2105/AJPH.2015.302902


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2comments
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Anonymous December 18, 2015 7:02 AM
Really? Last I checked, fortified flour is not the only source of folate available in the human diet. Not even close. I find it to be very easy to meet recommendations without fortified breads.
1 Reply » Reply
Thanks for your comment. You are correct, fortified flour is not the only source of folate in the diet. There are many sources of folate, particularly plant foods such as green leafy vegetables, and my favorite, lentils. It is great that you are able to meet folate intake recommendations even when you choose not to consume fortified grain products. Unfortunately, many people do not meet folate recommendations, and flour fortification has made a large impact on both folate intakes and the rate of neural tube defects. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751812/
-Julia
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