Lack of Vitamins Containing Folic Acid and Diabetes-Associated Birth Defects

Recently, the American Journal of Obstetrics and Gynecology published a CDC study: “Lack of Periconceptional Vitamins or Supplements That Contain Folic Acid and Diabetes Mellitus-Associated Birth Defects”. You can read the abstract of the article hereExternal Web Site Icon. The findings from this article are summarized in the following text.

Main study findings

Results from this study suggested that babies born to mothers with preexisting diabetes who did not take a vitamin containing folic acid might be at increased risk for birth defects compared with babies born to mothers with preexisting diabetes who did take a vitamin containing folic acid before and during early pregnancy.

However, the interpretation was limited by the relatively small number of mothers who had preexisting diabetes and did not use vitamins or supplements that contained folic acid and the lack of information on the level of diabetes control among these women.

Diabetes—A disease that affects the body’s blood sugar

Diabetes is a condition in which the body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. The body either makes no insulin or too little insulin or cannot use the insulin it makes to change those sugars and starches into energy. As a result, extra sugar builds up in the blood. Poor control of diabetes during pregnancy increases the chances for having a baby with a birth defect1-3 and can result in other problems for the baby. It also can cause serious complications for the mother.

More than 60% of women with preexisting diabetes have unplanned pregnancies, lack access to prenatal care, or might have trouble keeping their blood sugar under control, or a combination thereof.4-6 For these reasons, it is important to understand if other actions taken before and during pregnancy can help reduce the risk of having a baby with a birth defect for these women. A recommendation supported by the American Diabetes Association is for women with preexisting diabetes to consume 400 micrograms of folic acid daily if they are capable of becoming pregnant, and to increase their consumption to 600 micrograms of folic acid daily if they are pregnant or planning to become pregnant.7,8 However, currently there is limited evidence to show that folic acid might reduce the risk of having a baby with a birth defect for women with diabetes.

In a previous study using data from the National Birth Defects Prevention Study (NBDPS), preexisting diabetes was reported by 0.5% of mothers of a baby born without a birth defect and 2.4% of mothers of a baby born with a birth defect; preexisting diabetes was responsible for a twofold to fourfold increased risk of a wide array of major birth defects.1 In the current study, NBDPS researchers examined whether not taking vitamins containing folic acid before and during early pregnancy could increase the risk of having a baby with a birth defect among women with preexisting diabetes.

Diabetes during pregnancy:

The CDC is working to address diabetes during pregnancy with the following activities:

- Research:  CDC funds a large study of birth defects called the National Birth Defects Prevention StudyExternal Web Site Icon. This study is working to identify risk factors for birth defects and to answer questions about the effects of diabetes during pregnancy.

- Materials Development: Through research, CDC has found that a lack of knowledge and awareness about the need to control diabetes before and during pregnancy exists among women and health care providers. As a result, CDC has created educational materials on gestational diabetes and preexisting diabetes and pregnancy, in both English and Spanish.