Skip to content

Prenatal Exposure to Folic Acid-fortified Foods May Reduce Mental Illness Risk

In This Article

  • Increased in utero folic acid exposure is associated with changes in later brain development that predict a reduced risk for symptoms of psychosis
  • Young people born after full implementation of folic acid fortification in the U.S. had different patterns of cortical maturation compared with those born before the program
  • Brain imaging provides biological evidence that helps support a cause-and-effect relationship between prenatal folic acid exposure and the prevention of severe psychiatric disorders

Fortification of grain-based food with folic acid was implemented in the U.S. between 1996 and 1998 to protect children against neural tube defects such as spina bifida. This created a unique opportunity to study the development of young brains before and after folic acid fortification.

Research led by Joshua Roffman, MD, MMSc, co-director of Mass General Neuroscience, compared brain images of school-aged children born just prior to the fortification mandate to those of young people born afterwards. This analysis, published in JAMA Psychiatry, found that increased in utero folic acid exposure was associated with changes in later brain development. These brain changes, in turn, predicted a reduced risk for symptoms of psychosis.

The study compared two sets of brain MRIs taken of youths ages 8 to 18 who were born between 1993 to 2001: 292 Mass General patients, with images taken as a part of normal clinical care, and 861 participants in the Philadelphia Neurodevelopmental Cohort, a study that included assessment of psychiatric symptoms.

Both of sets of images were divided into three groups according to probable prenatal exposure to folic acid:

  • Those born before July 1, 1996, when fortification began
  • Those born after July 1, 1998, when implementation was complete
  • Those born in the intervening two years, for whom group exposure would have been intermediate

Analysis of the images revealed that young people born after full implementation of folic acid fortification had different patterns of cortical maturation compared with children born before the program began. These brains showed thicker brain tissue and delayed thinning of the cerebral cortex, which itself was associated with a significantly reduced risk of symptoms of psychosis.

There is currently no known prevention or cure for severe mental illnesses like autism and schizophrenia, but the research team believes these folic acid findings are a step in the right direction.

Learn more about the Psychiatric Neuroimaging Division

Learn more about the Department of Psychiatry

Related topics


Previous research has shown that diagnostic codes routinely collected in electronic health records can help predict domestic abuse an average of two years in advance. Could EHR systems also be used to predict suicidal behavior?


To examine how cannabis use affects the brain, most studies use positron emission tomography, which exposes subjects to radiation. Mass General researchers examined whether functional near-infrared spectroscopy is a feasible alternative for such research.