Corn chips, tortillas, tamales and pupusas 鈥� while all delicious may be missing a key vitamin for women of reproductive age.
has long been used to prevent serious birth defects and help babies develop. Medical and public health experts advise daily consumption during pregnancy, but also in the months before becoming pregnant. This B vitamin is so important the federal government requires such as enriched breads and cereals.
Now a California lawmaker is carrying a bill that would require manufacturers of corn masa flour 鈥� used to make many classic Latino foods 鈥� to also add folic acid to their products. , a Fresno Democrat and physician, is carrying . The legislation would require that producers add 0.7 milligrams of folic acid to every pound of masa, and that this addition be reflected in the nutrition label.
Arambula wants to address clear disparities in who gets the necessary amount of folic acid. show that Latinas are less likely to take folic acid in the early weeks of pregnancy or before becoming pregnant when compared to other racial or ethnic groups. This puts them at higher risk of having children born with birth defects of the brain and spinal cord, most commonly and .
Folic acid, or synthetic folate, promotes healthy cell growth. Research has shown that when taken before and in the early weeks of pregnancy, folic acid can help prevent birth defects by as much as 70%.
鈥淔ood is the best way that we can get folic acid into our communities before they鈥檙e pregnant,鈥� Arambula told CalMatters. 鈥淥ftentimes the prenatal vitamins that we give to pregnant people are too late.鈥�
That鈥檚 because the brain and spine begin to form within the first four weeks of gestation. Many people may not even know they鈥檙e pregnant during this time, especially when the pregnancy is unplanned.
The U.S. Food and Drug Administration followed that rationale when it handed down a mandate in 1998 requiring folic acid fortification in enriched grain products, including cereals, breads, pasta and rice. Since that rule took effect, the proportion of babies born with neural tube defects 鈥� about 1,300 fewer babies every year 鈥� according to the Centers for Disease Control and Prevention.
The FDA did not include corn masa flour in its folic acid mandate. Continuing to leave it out is 鈥渁 real oversight,鈥� Arambula said. Culturally, the diets of many Latinos, especially of immigrants and first generation residents, often rely heavily on corn flour.
Latinas get less folic acid
Dr. Megan Jones sees many high-risk pregnancies among Latina farmworkers as a maternal-fetal medicine specialist on California鈥檚 Central Coast.
She sees babies born with neural tube defects, cleft lips and cardiac defects, among other problems.
鈥淲e just had two babies with spina bifida in the last six months, they came kind of back to back. It鈥檚 not like I would say this is something we see every month, but a neural tube defect is a big deal,鈥� Jones said. 鈥淭his impacts the kid鈥檚 ability to walk, to be able to use the restroom, orthopedic stuff. This is a huge undertaking for a family. I would say in general, even seeing three or four of these in a year has a big impact on a community.鈥�
And while it鈥檚 difficult to pinpoint what exactly is to blame in each case, hypertension, diabetes and folic acid deficiencies can play a significant role, she said.
The CDC advises that all women of reproductive age get 400 micrograms of folic acid, much of which can be found in prenatal and women鈥檚 multi-vitamins. But Latinas and Black women are less likely to be taking these before pregnancy.
Between 2017 and 2019, the latest years for which state data is available, reported taking folic acid the month before becoming pregnant, according to the California Department of Public Health. That compares to 46% of white women. , the state鈥檚 program for low-income people, are also less likely to take folic acid before pregnancy compared to women on private insurance.
Regionally, women in the San Joaquin Valley and in the very northern part of the state were less likely to take folic acid.
Voluntary vs. mandated folic acid in foods
In 2008, Mexico began requiring that corn masa be strengthened with folic acid, but enforcement of that mandate has lagged, conducted by Columbia University and Mexico鈥檚 National Institute of Public Health.
Meanwhile, the U.S. government has long acknowledged the potential benefits of fortifying corn masa with folic acid, but still does not require it. , the CDC wrote: 鈥淔ortification of corn masa flour products could increase folic acid intake by nearly 20 percent for Mexican-Americans, who are at a 30-40 percent higher risk for a number of severe brain and spinal birth defects.鈥�
With mounting data and advocacy, in April 2016 to allow manufacturers of corn masa flour to add folic acid to their products. That was voluntary and producers have been slow to act. Two years after the FDA鈥檚 announcement, a study published in the Journal of the American Medical Association found that contained folic acid; none of the corn tortillas tested did.
The Center for Science in the Public Interest, a consumer advocacy organization, did its own from 2018-2022 and found folic acid in only 14% of corn masa flours and found none in the 476 corn tortilla products analyzed.
Arambula鈥檚 legislation is sponsored by the American College of Obstetricians and Gynecologists. The bill has made it out of its first policy committee, and so far has no registered opposition.
The March of Dimes, which advocates for maternal and infant health, for years has advocated for folate to be added to corn masa, so that more women can get folic acid through their diets. Advocates there believe California鈥檚 decision can have national influence and bring the issue back to the forefront, said David Pisani, director of advocacy and government affairs at March of Dimes.
鈥淔olic acid hasn鈥檛 been on the tips of people鈥檚 tongues for quite some time,鈥� Pisani said. 鈥淵ou don鈥檛 read about it, you don鈥檛 hear about it, and I think it鈥檚 because there is this misunderstanding that well, isn鈥檛 it already in everything most people are consuming? Obviously, the answer is not every product.鈥�
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