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California is the first state to require folic acid in corn masa flour. That's the key ingredient in foods like tortillas. Experts say that could help prevent serious birth defects, which occur at higher rates among Hispanic families. KQED's Lesley McClurg reports.
LESLEY MCCLURG, BYLINE: When AlmaRosa Alarcon began labor, she persevered without an epidural. She wanted to deliver her baby naturally. The 27-year-old had a healthy pregnancy. But the birth didn't go as planned.
ALMAROSA ALARCON: When the doctor held her up and we seen her little legs, the club feet.
MCCLURG: Her baby's feet were twisted inward. Doctors diagnosed the baby, Caterina, with spina bifida, a birth defect that happens when the neural tube - the structure that becomes the brain and the spinal cord - doesn't fully close early in development.
ALARCON: I didn't think it was real. I was in shock.
MCCLURG: Paramedics airlifted the newborn, Caterina, from Albertville, Alabama, to a hospital in Birmingham. Alarcon stayed behind to recover.
ALARCON: I was living in darkness. Like, it was horrible.
MCCLURG: The baby was in the hospital for two weeks struggling with nerve damage and complications like hydrocephalus - fluid building up in the brain. The medical saga continued through childhood. Sometimes Alarcon drove her daughter to three doctor visits every week.
ALARCON: We would have to go, like, an hour and 20 minutes away.
MCCLURG: She learned that her daughter's condition could be linked to a lack of folic acid during pregnancy - that's a B vitamin. Back in 1998, the government began requiring folic acid in refined grains like bread and pasta. Since then, rates of spina bifida have dropped by about 30% nationwide. But one major staple was left out, corn masa.
ALARCON: Tortillas are a must, and if we don't have tortillas, it just doesn't taste good.
MCCLURG: In the U.S., about 1 in 1,500 babies are born each year with neural tube defects, and experts say many could be prevented with enough folic acid. Shilpa Mathew is an OB-GYN in Sacramento.
SHILPA MATHEW: It's really important to have that vitamin right at the beginning of pregnancy when there's rapid cell division and tissue formation.
MCCLURG: She recommends women of childbearing age take folic acid daily. A baby's spine begins forming almost immediately, often before someone even knows they're pregnant.
MATHEW: You know, birth defects are some of the hardest situations we navigate. I've had patients who have chosen to terminate a pregnancy because the defect can be so severe, or I even had a patient who had to have surgery on the baby during pregnancy.
MCCLURG: But critics are against fortification, seeing it as government overreach. Health Secretary Robert F. Kennedy Jr. called California's new law insanity in a post on X, but didn't explain further. Others on social media claim that people with certain genetic differences can't properly process the vitamin, but medical experts say that science does not back that. Some have pushed back for cultural reasons, arguing that folic acid in foods like tortillas interferes with culinary heritage. The final version of the law reflects some of that pushback. Sharon Bustrak works with the Food Fortification Initiative. She helped craft the legislation.
SHARON BUSTRAK: We make a point of having exceptions for small-scale producers.
MCCLURG: She says that's both to preserve consumer choice and because fortification can be more expensive at that scale. Also, snack foods are excluded.
BUSTRAK: Doritos, Fritos, tortillas, chips. Yes, there is a specific exemption for those.
MCCLURG: She says snack food companies lobbied for exemptions, arguing the rule would be costly and difficult to implement. NPR reached out to several, and they didn't respond. Even with those carve outs, Alarcon is grateful for any change that could spare other families.
ALARCON: 'Cause I don't wish what I've been through upon nobody, and if that can help, I mean, why not, you know?
MCCLURG: After countless surgeries, Caterina is stable today, but life is still challenging for the now-12-year-old.
CATERINA: I have chronic pain in my hips, my knees, my back.
MCCLURG: She wears leg braces and sometimes relies on a wheelchair. She struggles with migraines, but she's also a strong student. She loves reading and anime, and she has big plans.
CATERINA: Because I am actually a rising public speaker.
MCCLURG: She wants to make sure people with disabilities are accurately represented.
For NPR News, I'm Lesley McClurg.
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