The survey results, published in the September 30 issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR), highlight the need to increase folic acid fortification of the grain supply, the March of Dimes says.

Daily use of folic acid has not shown a substantial increase between 1995 and 2005 despite nationwide educational efforts by the March of Dimes and other agencies.

The results of the survey, conducted for the March of Dimes by The Gallup Organization with funding from the U.S. Centers for Disease Control and Prevention, highlight the need to increase folic acid fortification of the grain supply, the March of Dimes says.

"Folic acid must be part of women's daily diet. That's the best way we know to spare thousands of babies the risk of death or disability caused by neural tube defects,'' said Dr. Jennifer L. Howse, president of the March of Dimes. "The survey results show that despite our efforts and those of other organizations, two-thirds of women ages 18-45 are not taking all the necessary steps to help reduce the risk of neural tube defects. We need to increase the amount of folic acid in the grain supply and add it to corn flour. That way, women will get most of the folic acid they need through a healthy diet - without having to think about it - and their babies will be safer."

Currently, enriched grain foods in the United States must contain 140 micrograms of folic acid per 100 grams of grain.

Neural tube defects (NTDs), such as spina bifida and anencephaly, are among the most serious types of birth defects. Each year, NTDs affect about 3,000 pregnancies. To help prevent NTDs, the March of Dimes says, all women capable of becoming pregnant should take a multivitamin containing at least 400 micrograms of folic acid every day beginning before pregnancy, as part of a healthy diet containing foods fortified with folic acid and foods that naturally contain folic acid, such as leafy green vegetables, and beans. Studies show that, if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all NTDs could be prevented.

Daily consumption of folic acid beginning before pregnancy is crucial because NTDs occur in the early weeks after conception, often before a woman knows she is pregnant. The number of women who said they had heard of folic acid reached an all-time high in the 2005 survey at 84 percent, up from 52 percent in 1995. The most common reason women gave for not taking the supplement daily is that they forgot.

The March of Dimes survey on folic acid has been conducted nine times since 1995. In 2005, 2,647 women between the ages of 18 and 45 were asked about their awareness and knowledge of the benefits of folic acid and their use of vitamins. For results based on samples of this size, one can say with 95 percent confidence that the error attributable to sampling and other random effects could be plus or minus two percentage points.

The also survey found:

Nearly 90 percent of women surveyed believe there are things they can do to prevent births defects. These women cited avoiding alcohol and drugs and not smoking as the top two things that could be done to prevent birth defects, followed by proper diet and vitamins. Only 9 percent of the women mentioned folic acid. Folic acid use declined to 33 percent in 2005, down from 40 percent in 2004. However the 2005 rate is consistent with years prior to 2004. Only 24 percent of younger women (age 18-24) take a vitamin containing folic acid daily compared to 36 percent of older women (age 25 to 45). Only 7 percent of women surveyed knew folic acid should be taken before pregnancy. Of women who didn't take a multivitamin daily, 28 percent said it was because they forget, 16 percent said they don't need them, and 9 percent said they get the nutrients and vitamins they need from food.

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