Fifteen years after she lost her first baby to a rare and devastating birth defect, Andrea Lopez takes comfort in knowing that other Latina mothers might finally avoid the same pain.
In January, California became the first state to require food makers to add folic acid, a crucial vitamin, to corn masa flour used to make tortillas and other traditional foods widely used in her community.
It’s a long-delayed move aimed at reducing Hispanic infants' disproportionately
high rates of serious conditions called neural tube defects, which claimed Lopez’s son, Gabriel Cude, when he was 10 days old.
“It’s such a small effort for such a tremendous impact,” said Lopez, 44, who lives in Bakersfield and is now a lawyer with two young daughters. “There is very little that I wouldn’t do to spare anybody this heartache.”
A similar law takes effect in Alabama in June, and legislation is pending or being considered in Florida, Georgia, Oklahoma and Oregon. Four more states — Texas, Delaware, New Jersey and Pennsylvania — have expressed “active interest” in the issue, according to the Food Fortification Initiative, an advocacy group that focuses on addressing micronutrient deficiencies.
“All women and children in the United States should have access to folic acid and have healthy babies,” said Scott Montgomery, the group's director.
For nearly 30 years, folic acid, a key B vitamin, has been required to be added to enriched wheat and white breads, cereals and pastas in the U.S.
Decades of research show the 1998 requirement cut rates of serious defects such as spina bifida and anencephaly by about 30%, preventing about 1,300 cases a year. It is regarded as one of the top public health triumphs of the 20th century.
But corn masa flour, a staple used in Latino diets, was left out of the original fortification requirement — and rates of conditions such as spina bifida and anencephaly in that community have remained stubbornly high.
In 2016, federal regulators allowed, but did not require, folic acid to be added to corn masa products. By 2023, only about 1 in 7 corn masa flour products and no corn tortillas contained folic acid, a review found.
Nationwide, Hispanic women have the highest rates of having those defects during pregnancy. In California, the rate among Hispanic mothers is twice as high as for white or Black women, state data show.
California’s new law — and the state’s huge buying power — could help expand its adoption nationwide, said state Assemblymember Joaquin Arambula, who sponsored the legislation passed in 2024.
“You have to be the first oftentimes to get the ball rolling,” he said. “So, I’m glad other states have taken up that mantle.”
California’s action and pressure from advocates have already spurred changes.
Gruma Corp., the parent company of Mission Foods and Azteca Milling, has been involved in the fortification issue for nearly two decades. Azteca began selling some — but not all — varieties of Maseca, its largest brand of corn masa flour, with folic acid in 2016.
As of this year, 97% of the company’s retail sales in the U.S. include folic acid. The rest are expected to be fortified before July, Gruma said in a statement.
Mission Foods began fortification in 2024. It now adds folic acid to all of its branded and private label corn tortillas in the U.S.
Such actions by large producers have helped pave the way for smaller manufacturers to follow suit, according to a recent report by the Center for Science in the Public Interest, a consumer advocacy group that has pushed for fortification.
Initially, the industry was concerned folic acid could affect flavor and the cost of changing labels, said Jim Kabbani, head of the Tortilla Industry Association. But he now expects tortilla makers will start selling fortified products on a broader scale.
“I think overall the train has left the station and it will be more and more states,” he said.
Public health experts cheer the growing momentum.
“The science is clear: Folic acid fortification works,” said Vijaya Kancherla, an Emory University epidemiology professor and director of the Center for Spina Bifida Prevention. “It’s safe. It’s proven. And it’s cost-effective.”
That view contrasts sharply with critics — including some at the highest level of government — who regard fortification of the food supply as a form of government overreach.
Late last year, Health Secretary Robert F. Kennedy Jr. criticized California's new law in a post on X: “This is insanity. California is waging war against her children — targeting the poor and communities of color,” he wrote.
A spokesman for Kennedy declined to explain the comments.
Social media feeds are rife with people claiming that folic acid fortification is “toxic” or that people with a certain gene variation known as MTHFR can’t properly process the vitamin.
None of those claims is accurate, according to advocates and medical experts.
“What’s truly insane is that our nation’s top health official is spreading false claims and frightening people into avoiding a nutrient that’s proven to prevent birth defects and save babies' lives,” said Eva Greenthal, CSPI’s senior policy scientist.
At fortification doses, folic acid “has never been shown to harm individuals or populations,” said Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects in the U.S. and globally.
The U.S. Centers for Disease Control and Prevention emphasizes that “people with the MTHFR gene variant can process all types of folate, including folic acid.”
Even Kennedy’s new federal dietary guidelines support fortification. Documents backing the guidelines advise pregnant women to eat folate-rich foods, such as leafy green vegetables, beans and lentils. But they also acknowledge that folic acid from fortified foods or supplements is “critical” before conception and during early pregnancy to prevent neural tube defects.
“Folic acid fortification of corn masa flour could help prevent” neural tube defects, the CDC website adds.
Neural tube defects, which affect about 2,000 babies each year in the U.S., occur in the first weeks after conception, when the tube that forms the spine and brain fails to develop properly.
That’s often before many women realize they’re pregnant. More than 40% of U.S. pregnancies are unintended. In those cases, many women won't have been preparing for pregnancy, noted Dr. Kimberly BeDell, medical director of a rehabilitation clinic that helps children with spina bifida at Miller Children’s Hospital in Long Beach, California.
“Even women’s best efforts in going to an OB right away and starting prenatal vitamins, it’s just too late,” BeDell said.
Adding folic acid to corn masa, the way it is added to other grains, is a way to ensure the nutrient reaches the wider population that needs it, she added.
At age 28, pregnant with her first child, Andrea Lopez didn’t know about the importance of folic acid or that the vitamin might be missing from her diet.
Then, an ultrasound mid-way through pregnancy showed that her baby had anencephaly, a fatal condition in which the skull fails to develop properly.
Lopez carried the pregnancy to term and Gabriel lived for 10 days. The pain of his loss never goes away, she said, adding that Gabriel would have been a high school freshman this year. She supports California’s law requiring folic acid fortification of corn masa and finds it “mind-boggling” that the action took so long to enforce.
“Trust me, you don’t want to go through this,” she said. “He’s the love of my life. I have two little girls that survived, but he’s my first born. He is my only son.”
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