California has become the first state to mandate folic acid fortification in corn masa flour to prevent serious birth defects in Latino communities. Delaware is among several states showing active interest in similar legislation after decades of research proved the vitamin's effectiveness.
A mother from California who lost her newborn son to a devastating birth defect fifteen years ago now finds hope in a groundbreaking new law that could prevent other families from experiencing similar tragedy.
This past January, California implemented the nation’s first mandate requiring manufacturers to fortify corn masa flour with folic acid, a vital B vitamin. The regulation targets tortillas and other traditional foods commonly consumed in Latino households.
The initiative addresses the alarmingly high occurrence of neural tube defects among Hispanic babies, the same type of condition that took the life of Andrea Lopez’s son Gabriel Cude after just ten days.
“It’s such a small effort for such a tremendous impact,” expressed Lopez, age 44, who resides in Bakersfield and now practices law while raising two daughters. “There is very little that I wouldn’t do to spare anybody this heartache.”
Alabama will implement comparable legislation this June, while Florida, Georgia, Oklahoma and Oregon are advancing similar proposals. According to the Food Fortification Initiative, an organization dedicated to combating nutritional deficiencies, four additional states including Delaware, Texas, New Jersey and Pennsylvania have demonstrated “active interest” in pursuing this public health measure.
“All women and children in the United States should have access to folic acid and have healthy babies,” stated Scott Montgomery, who directs the advocacy organization.
The United States has mandated folic acid supplementation in enriched wheat products, white breads, cereals and pasta for nearly three decades.
Extensive scientific studies demonstrate that the 1998 mandate reduced severe birth defects like spina bifida and anencephaly by approximately 30 percent, preventing roughly 1,300 cases annually. Medical professionals consider this achievement among the most significant public health victories of the previous century.
However, corn masa flour, a dietary cornerstone for Latino families, remained exempt from the original fortification mandate — leaving rates of spina bifida and anencephaly persistently elevated within this population.
Federal authorities permitted voluntary folic acid addition to corn masa products in 2016 but stopped short of requiring it. Research conducted in 2023 revealed that only one in seven corn masa flour products contained folic acid, while no corn tortillas included the vitamin.
Hispanic women experience the highest rates of neural tube defects during pregnancy across the nation. California statistics indicate Hispanic mothers face twice the risk compared to white or Black women.
State Assemblymember Joaquin Arambula, who championed the 2024 legislation, believes California’s new requirements and substantial market influence could drive nationwide adoption.
“You have to be the first oftentimes to get the ball rolling,” he explained. “So, I’m glad other states have taken up that mantle.”
California’s leadership and advocacy pressure have already prompted industry changes.
Gruma Corporation, which owns Mission Foods and Azteca Milling, has engaged with fortification efforts for nearly twenty years. Azteca introduced folic acid to select varieties of Maseca, its primary corn masa flour brand, beginning in 2016.
Currently, 97 percent of the company’s domestic retail products include folic acid supplementation. The remaining products will receive fortification before July, according to a Gruma statement.
Mission Foods launched its fortification program in 2024, now incorporating folic acid into all branded and private label corn tortillas sold domestically.
The Center for Science in the Public Interest, a consumer advocacy organization promoting fortification, reports that major producers’ actions have encouraged smaller manufacturers to adopt similar practices.
Jim Kabbani, who leads the Tortilla Industry Association, acknowledged initial industry concerns about flavor impact and labeling costs. However, he now anticipates widespread adoption of fortified products by tortilla manufacturers.
“I think overall the train has left the station and it will be more and more states,” he predicted.
Public health professionals welcome the increasing support.
“The science is clear: Folic acid fortification works,” declared Vijaya Kancherla, an epidemiology professor at Emory University who directs the Center for Spina Bifida Prevention. “It’s safe. It’s proven. And it’s cost-effective.”
This perspective conflicts sharply with opponents, including some high-ranking government officials, who view food supply fortification as excessive government interference.
Health Secretary Robert F. Kennedy Jr. criticized California’s legislation in a social media post last year, writing: “This is insanity. California is waging war against her children — targeting the poor and communities of color.”
A Kennedy spokesperson declined to elaborate on these remarks.
Social media platforms contain numerous claims alleging folic acid fortification is “toxic” or that individuals with specific genetic variations called MTHFR cannot properly metabolize the vitamin.
Medical experts and advocates confirm these assertions are false.
“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,” responded Eva Greenthal, CSPI’s senior policy scientist.
Dr. Jeffery Blount, a pediatric neurosurgeon at the University of Alabama at Birmingham who works to prevent neural tube defects domestically and internationally, emphasized that folic acid “has never been shown to harm individuals or populations” at fortification levels.
The Centers for Disease Control and Prevention clarifies that “people with the MTHFR gene variant can process all types of folate, including folic acid.”
Ironically, Kennedy’s own federal dietary guidelines endorse fortification. Supporting documentation recommends pregnant women consume folate-rich foods like leafy vegetables, beans and lentils, while acknowledging that folic acid from fortified foods or supplements remains “critical” before conception and during early pregnancy for preventing neural tube defects.
“Folic acid fortification of corn masa flour could help prevent” neural tube defects, the CDC website confirms.
Neural tube defects impact approximately 2,000 American babies annually, developing during the initial weeks following conception when the structure forming the spine and brain fails to develop correctly.
This timing often precedes women discovering their pregnancies. With more than 40 percent of U.S. pregnancies being unplanned, many women lack pregnancy preparation, noted Dr. Kimberly BeDell, medical director of a spina bifida rehabilitation clinic 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 explained.
Incorporating folic acid into corn masa, similar to other grain fortification, ensures the nutrient reaches the broader population requiring it, she added.
At 28 years old and expecting her first child, Andrea Lopez remained unaware of folic acid’s importance or its potential absence from her diet.
A mid-pregnancy ultrasound revealed her baby had anencephaly, a fatal condition preventing proper skull development.
Lopez continued the pregnancy to term, and Gabriel survived ten days. She says the grief never subsides, noting Gabriel would be a high school freshman today. She endorses California’s corn masa fortification law and finds the delayed implementation “mind-boggling.”
“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.”