Why you need folic acid?

If you’re pregnant or might become pregnant, it’s critically important to get enough folic acid, the synthetic form of vitamin B9, also known as folate.

Folic acid helps prevent neural tube defects (NTDs) – serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). The neural tube is the part of the embryo from which your baby’s spine and brain develop. NTDs affect about 3,000 pregnancies a year in the United States.

Neural tube defects occur at a very early stage of development, before many women even know they’re pregnant – which is why it’s important to begin taking folic acid before you start trying to conceive.

The Centers for Disease Control and Prevention (CDC) reports that women who take the recommended daily dose of folic acid starting at least one month before conception and during the first trimester of pregnancy reduce their baby’s risk of neural tube defects by up to 70 percent.

Some research suggests that folic acid may help lower your baby’s risk of other defects as well, such as cleft lip, cleft palate, and certain types of heart defects. It may also reduce your risk of pre-eclampsia, a serious blood pressure disorder that affects about 5 percent of pregnant women.

What else does folic acid do for you? Your body needs this nutrient to make normal red blood cells and prevent a type of anemia. It’s also essential for the production, repair, and functioning of DNA, our genetic map and a basic building block of cells. Getting enough folic acid is particularly important for the rapid cell growth of the placenta and your developing baby.

How much folic acid do you need?

To reduce your baby’s risk of developing a neural tube defect, experts recommend that you take 400 micrograms (mcg) of folic acid a day, beginning at least a month before you start trying to get pregnant.

In fact, because most pregnancies are unplanned, experts strongly recommend that all women of childbearing age take 400 mcg of folic acid every day.

If you’re taking prescription prenatal vitamins, they probably contain 800 to 1,000 mcg of folic acid. Check the label.
 
When you might need extra folic acid?

Women who are obese appear to be more likely to have a baby with a neural tube defect. If you’re significantly overweight, see your healthcare provider before you try to conceive. She may advise you to take more than 400 mcg of folic acid a day.

If you’ve previously been pregnant with a baby with a neural tube defect, you’ll probably be advised to take 4,000 mcg of folic acid a day. Be sure your current providers are aware of your history and schedule a visit before you try to get pregnant. With no intervention, women in this situation have a 3 to 5 percent chance of having another pregnancy complicated by an NTD.

If you’re carrying twins, your healthcare provider may recommend you take as much as 1,000 mcg of folic acid per day.

Some people have a genetic variation – known as a methylenetetrahydrofolate reductase (MTHFR) mutation – that makes it more difficult to process folate and folic acid. If you know you have this mutation, talk with your doctor to make sure you’re getting enough folic acid.

Women who are diabetic or are taking certain anti-seizure medications are also more likely to have a baby with an NTD. If either of these situations applies to you, see your provider at least a month before trying to conceive to find out how much folic acid you should be taking and to monitor your condition in general.

Sources of folic acid:

Foods that are naturally rich in folate are not a good source. Research shows that the body absorbs folic acid from supplements much better than the folate that occurs naturally in certain foods. What’s more, folate can be lost from foods during storage or destroyed by cooking.

So if you eat foods rich in folate, consider them a complement to your supplement. Good sources include:

• lentils
• dried beans, peas, and nuts
• avocado
• dark green vegetables such as broccoli, spinach, turnip greens, okra, Brussels sprouts, and asparagus
• citrus fruit and juice
 
Is supplementation necessary?

Yes. Many authorities, including Indian Council of Medical Research (ICMR), American College of Obstetricians and Gynecologists (ACOG) and the March of Dimes, recommend that all women of childbearing age take a multivitamin with folic acid or a folic acid supplement every single day.

Signs of a folic acid deficiency

The signs of folic acid deficiency can be subtle. You may have diarrhea, anemia, loss of appetite, and weight loss, as well as weakness, a sore tongue, headaches, heart palpitations, and irritability.

If you’re only mildly deficient, you may not notice any symptoms at all, but you won’t be getting the optimal amount for your baby’s early embryonic development.

Sources:

AAP. 1999. Policy statement: Folic acid for the prevention of neural tube defects. American Academy of Pediatrics. http://pediatrics.aappublications.org/content/104/2/325
ACOG. 2008. Practice bulletin 95: Anemia in Pregnancy. American College of Obstetricians and Gynecologists.
ACOG. 2003 (reaffirmed 2006). Practice bulletin 44: Neural tube defects. American College of Obstetricians and Gynecologists.
De Wals P, et al. 2007. Reduction in neural-tube defects after folic acid fortification in Canada New England Journal of Medicine 357:135-142.
Lumley J, et al. 2001. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database of Systematic Reviews (3):CD001056. http://www.ncbi.nlm.nih.gov/pubmed/11686974
NIH. Undated. Folate. National Institutes of Health. http://ods.od.nih.gov/factsheets/folate.asp
Rasmussen SA, et al. 2008. Maternal obesity and risk of neural tube defects: A metaanalysis. American Journal of Obstetrics and Gynecology 198(6):611-9. http://www.ncbi.nlm.nih.gov/pubmed/18538144
Ray JG, et al. 2005. Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstetrics & Gynecology105(2):261-5. http://www.ncbi.nlm.nih.gov/pubmed/15684149
Wen SW, et al. 2008. Folic acid supplementation in early second trimester and the risk of pre-eclampsia. American Journal of Obstetrics and Gynecology 198(1):45.e1-45.e7 http://www.ncbi.nlm.nih.gov/pubmed/18166303
Zeller JL, et al. 2006. Folic acid. 296(22):2758. http://jama.ama-assn.org/cgi/content/full/296/22/2758