Dr. Russell Kirby: folic acid awareness key to preventing neural tube defects

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January is National Birth Defects Prevention Month; Folic Acid Awareness Week is Jan. 8-14, 2017

Dr. Russell Kirby, USF distinguished professor and Marrell Endowed Chair in the College of Public Health’s Department of Community and Family Health, has co-edited a special issue of Birth Defects Research Part A: Clinical and Molecular Teratology, highlighting the latest birth defects research.

One study in particular, according to Kirby, indicated a decrease in birth defects prevention programs and folic acid awareness outreach efforts.

Dr. Russell Kirby. (Photo courtesy of USF COPH)

The study, “Using State and Provincial Surveillance Programs to Reduce Risk of Recurrence of Neural Tube Defects in the United States and Canada: A Missed Opportunity?” is part of a series of research articles using population-based data published as a “Special Issue: 2016 Congenital Malformations Surveillance Report: A Report from the National Birth Defects Prevention Network” for the November issue of Birth Defects Research Part A: Clinical and Molecular Teratology.

“The results of this study, conducted by Dr. Timothy J. Flood and his team, raises concerns since we have strong evidence for preventing neural tube defects (NTD) with high doses of folic acid in women who have already had a baby born with an NTD,” Kirby said.

Researchers examined U.S. and Canadian birth defects surveillance programs in 2015 to determine whether public health programs to ensure women who experienced a birth with a neural tube defect have access to supplements with a high dose of folic acid.  These women are a greater risk of having another baby with a neural tube defect, but this risk is greatly reduced by following higher preconception folic acid supplementation guidelines.

According to Kirby, two large randomized controlled trials published in the early 1990s have indicated that a larger dose of folic acid could prevent birth defects and largely reduce the likelihood of a women experiencing a subsequent pregnancy with a neural tube defect, such as spina bifida.

However, the current study conducted in 2015 found a nearly 50 percent decrease in the number of programs conducting neural tube defect recurrence outreach activities compared to 2005.

“We should ensure that a woman who has had a baby with this type of severe birth defect has access to the high folic acid supplementation necessary to avoid a repeat of this birth defect in subsequent pregnancies, but there are few formal statewide programs to do that,” Kirby said.

Women of reproductive age and those planning to get pregnant should consume 400 micrograms of folic acid daily, before pregnancy, according to Kirby. Women at risk of recurrence of a neural tube defect should consume 4 milligrams of folic acid daily.

Folic acid is a class of B vitamins and, according to Kirby, is one of the essential building blocks for the human body to make DNA, RNA and amino acids required for cell division.


While it can be found in some foods, such as broccoli or whole grains, Dr. Kirby indicated that a folic acid supplement is needed to reach the recommended 400 micrograms daily.

“Folic acid does not guarantee a woman will not have a neural tube defect, but it can prevent a large number of cases,” Kirby said.

Kirby said folic acid awareness is a necessary public health intervention and the birth defects registry, while facing some restraints based on state laws, may help tremendously in increasing awareness of the importance of folic acid.

He also stressed the importance of the 40 programs in the U.S. that maintain state-wide birth defects data.

“Other types of data don’t give the full picture,” he said. “This annual report is the cornerstone of epidemiologic and health services research and disease prevention.”


Kirby, R., Browne, M., editors (2016). Special Issue: 2016 Congenital Malformations Surveillance Report: A Report from the National Birth Defects Prevention Network. Birth Defects Research Part A: Clinical and Molecular Teratology; pages 863-988.


Story by Anna Mayor, USF College of Public Health