Birth Defects & Developmental Disabilities

Folic Acid and Fortification – An Interview with José F. Cordero, MD, MPH

Dr. José F. Cordero is an Assistant Surgeon General of the Public Health Service and the Director of the National Center on Birth Defects and Developmental Disabilities at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. A native of Puerto Rico, Dr. Cordero obtained his medical degree from the University of Puerto Rico, completed residency training in pediatrics at Boston City Hospital and a fellowship in medical genetics at the Massachusetts General Hospital. After obtaining his master’s in public health from Harvard University, Dr. Cordero joined the CDC as an Epidemiologic Intelligence Service officer. Dr. Cordero has 27 years of experience at the CDC and extensive public health experience in the fields of birth defects, developmental disabilities, infant and child health, immunizations, and efforts to promote the health of children and adults with disabilities throughout the lifespan. We recently had an opportunity to speak with Dr. Cordero about the role of folic acid in preventing birth defects and about what more needs to be done to address higher rates of birth defects preventable by folic acid among Hispanics.

Q. What is folic acid and why is it important?

A. Folic acid is a B-vitamin that helps build healthy cells. Studies have shown that if taken before and during early pregnancy, folic acid can significantly reduce the number of birth defects of the brain and spine called neural tube defects (NTDs). The most common NTDs are spina bifida and anencephaly. Complications from spina bifida, a defect of the spinal column, can include paralysis, loss of bladder and bowel control, and learning disabilities. Anencephaly is a fatal condition in which the skull bones and brain fail to develop completely or are absent. Emerging research also suggests that folic acid might also reduce the risk of other birth defects such as cleft lip and palate and some heart defects. It is essential for women of childbearing age to get 400 micrograms of folic acid each and every day because doing so can reduce their risk of having a pregnancy affected by neural tube defects by up to 70%. Since half of all pregnancies in the United States are unplanned it’s important that all women get the right amount of folic acid, whether or not they are thinking about getting pregnant. This is particularly important because the neural tube develops very early in pregnancy, often before a woman even knows she is pregnant. Women can get the recommended amount of folic acid by taking a multivitamin and eating a variety of foods as part of a healthy diet. That includes eating enriched or fortified grain products along with fruits and vegetables..

Q. Why is fortification so important?

A. Fortification refers to the inclusion of certain vitamins in food products. Given the evidence that folic acid consumption prevents birth defects, the Food and Drug Administration mandated that certain grain products and flours be fortified with folic acid. Fortification refers represents a breakthrough for public health. There are so many unknowns surrounding pregnancy and birth defects. When we have scientific evidence that something works, it’s important to put that into practice. Today, fortified breads, pasta, rice, and flour are widely available, and many breakfast cereals also contain folic acid. By taking the research on folic acid and applying it, we are able to saves lives and prevent disability. Since fortification was required, rates of neural tube defects have gone down almost 30%. Despite these successful declines, rates remain highest among Hispanics.

Q. Are corn products fortified?

A. Corn flour is an important staple of the Hispanic diet, but only a few brands of corn flour are fortified. Increasing the availability of corn flour fortified with folic acid could be an important strategy to reduce the high rates of birth defects preventable by folic acid among Hispanics. Rules by the Food and Drug Administration require that all grain products labeled as “enriched” contain folic acid, but certain popular corn flour and corn meal products in the United States do not carry this label and thus are not required to include folic acid in their products. It’s very important that women read the labels of the products that they buy. If it says “enriched,” it means that the product has been fortified with several important vitamins including folic acid. More enriched corn products on the shelves would give Hispanic women more opportunities to consume enough folic acid.

Q. What can HMHB partners do?

A. All those who work with women of childbearing age can help us meet the challenge of sharing the message that it is important to take 400 micrograms of folic acid every day – before, during, and even after pregnancy. Right now, it’s especially important that partners working with Hispanic women become involved in the National Council on Folic Acid campaign because their constituents have higher rates of birth defects preventable by folic acid. We need assistance from those who work with Hispanic women to target educational efforts toward these consumers so that they will increase their consumption of folic acid and eat fortified grains as part of a healthy diet in addition to a healthy diet of fruits and vegetables. We encourage consumers to join us in asking for the fortification of corn products so that every baby has the best possible chance at a healthy start in life!

For more information, go to the National Council on Folic Acid Website at or the CDC’s National Center on Birth Defects and Developmental Disabilities at To order free folic acid materials in English and Spanish, visit