Folic Acid in Pregnancy: Benefits, Deficiency Dangers, Food Sources

What is folic acid?

Taking folic acid when pregnant forms one of the most important nutrients prescribed or recommended during pregnancy. It belongs to the water-soluble vitamin B family.

Folic acid is the synthetic form of vitamin B9 used in supplements and fortified foods and folate is the naturally occurring form of the vitamin.

Your body does not produce folate, so you must obtain it through diet. The folate provided by the foods is not biologically active and will provide no benefits.

The liver breaks down the folate in foods into methyl folate, which your body can then use.

Though doctors prescribe multivitamin supplements during pregnancy, separate folic acid supplements are also advised because its critical importance during pregnancy can be gauged from the harmful effects its deficiency can have on the baby.

Why take folic acid during pregnancy? Benefits

Folic acid is essential for the proper development of the nervous system of the baby and for a healthy pregnancy.

Its role is basic and important in the formation of cells and tissues, development of DNA, its repair and function. It also prevents changes to the DNA, which can lead to cancer. It also promotes the formation of red blood cells.

Its function is particularly important for rapid cell growth of the placenta and the growing baby.

Taking adequate folic acid reduces the risk of neural defects in the baby by 70% and also greatly reduces the risk of preeclampsia in the pregnant woman.

Preeclampsia is a serious condition in which the pregnant woman develops high blood pressure and can have adverse effects on the pregnancy if not taken care of. It affects about 5% of the pregnant women.

Folic acid also reduces nausea and vomiting associated with the pregnancy morning sickness.

Adequate folic acid during pregnancy will prevent

Besides the dangers mentioned above, when adequate doses of folic acid are taken before and during pregnancy, it will help pregnancy to full term and will prevent its termination.

It will protect your baby against:

  • Premature birth
  • Low birth weight
  • Miscarriage
  • Improper growth in the womb

Folic acid deficiency during pregnancy: Dangers

Proper intake of folic acid during pregnancy prevents birth defects in the baby such as neural tube defects (NTDs), birth defects of the spinal cord (such as spina bifida), cleft lip, cleft palate and congenital heart diseases.

The neural tube is that part of the embryo from which the baby’s brain and the spine develop.

Deficiency of folic acid in a pregnant woman causes anemia and increases the risk of miscarriage and stillbirth. Another neural defect that folic acid deficiency can cause is anencephaly where the brain of the baby is not completely developed.

Babies who survive these neural defects are paralyzed throughout life. Babies with anencephaly usually do not live for long, and spina bifida may cause permanent disability.

According to The Centers for Disease Control and Prevention (CDC), about 3000 babies are born with neural tube defects every year in the United States.

Folate deficiency can also result in a lethargic lifestyle, impaired brain function, and mood disorders.

When should you start taking folic acid?

The neural tube defects in the fetus due to folic acid deficiency develop during the first month of pregnancy because that is when the brain and the spinal cord of the baby are developing.

It is, therefore, important that enough intake of folic acid be made necessary not just after your pregnancy is established but even when you are planning to conceive.

And since 50% of the pregnancies are accidental or unplanned, it is essential that a woman must ensure that her diet contains enough amounts of this vitamin during her child-bearing age.

A study revealed that women who were folic acid sufficient by taking its supplements for a year before pregnancy increased their chances of a normal full term delivery by 50%.

Since folic acid promotes the formation of red blood cells, its deficiency can also cause anemia in the pregnant woman and the consequences associated with it.

How much is the folic acid requirement and what is its dose in pregnancy?

The CDC, the U.S. Public Health Service, the American College of Obstetricians and Gynecologists (ACOG) emphatically recommend that all women of child-bearing age should make sure that they consume 400 micrograms (mcg) of folic acid every day. This is irrespective of whether you are pregnant or not.

The reason for this is that about 50% of the pregnancies are unplanned and if you do conceive, this intake will ensure that you are not in a state of this vitamin deficiency.

After you do become pregnant, the U.S. National Institutes of Health recommends that you increase your intake to 600 mcg. In the case of twins, your ob-gyn may advise 1,000 mcg of folic acid per day.

During your breastfeeding days, you should get about 500 mcg of this nutrient every day.

If you have a history of a previous pregnancy in which you have delivered a baby with a neural tube defect, you should increase your intake to 4000 mcg.

According to the CDC, this will reduce your risk of having another baby with a neural tube defect by as much as 70%.

You should receive this dosage at least three months before you conceive and also for the first three months of your pregnancy.

Folic acid 5 mg during pregnancy

Some women are at an increased risk of developing a baby with neural tube defects. Such women are advised to take folic acid 5 mg tablets every day till they are 12 weeks into pregnancy. 5 mg equals 5000 mcg.

Such women with an increased risk include:

  • you or your husband have a neural tube defect
  • your previous pregnancy was affected by a neural tube defect
  • a family history of neural tube defects in one or both the partners
  • you have diabetes

For how long should you take folic acid and when should you stop?

The folic acid requirement is most critical three months before you conceive and during the first trimester of pregnancy.

But, you should continue taking it after those 12 weeks throughout pregnancy and well through your breastfeeding days.

If there is a possibility of a further pregnancy, you should continue taking your folic acid till that possibility exists.

You don’t want to get pregnant accidentally with a folic acid deficiency. The dangers mentioned above are too serious to ignore.

As mentioned above, the health organizations advocate that you continue with your daily dose of 400 mcg throughout your reproductive years.

Does folic acid help you get pregnant?

Folic acid deficiency causes anemia, which according to Mayo clinic does reduce your fertility.

Secondly, with not enough nutrients in your daily intake, it can be difficult to track ovulation for conceiving purposes.

Folic acid supplements in pregnancy

Looking at its importance, enough intakes of folic acid foods and its supplements should be ensured not just during pregnancy but also about three months before you are planning to become pregnant and during the breastfeeding period also.

Though your diet will have enough of folates, folic acid supplements are also advised to ensure that you do get enough of this nutrient. Folic acid is a water-soluble vitamin and excess of it is excreted in urine.  It is best left to your doctor to prescribe the best supplement for you.

When you buy a multivitamin supplement or your prenatal vitamins, be sure to check the content of folic acid from the label.

If necessary, buy a separate folic acid supplement to fulfill your requirement. Take only one multivitamin in a day.

Conditions that interfere with folic acid absorption

  • Some people are born with a genetic variation known as a methylenetetrahydrofolate reductase (MTHFR) mutation. About 50% of the population has this genetic variation that makes it more difficult to process folate and folic acid. Such people should talk to their doctor before planning to become pregnant so that she can take remedial measures.
  • Maternal diabetes and maternal obesity increase the risk of neural tube defects in the baby by interfering with the normal metabolism of folic acid.
  • According to the Epilepsy Foundation, certain antiseizure medications such as phenytoin (Dilantin, Phenytek), carbamazepine (Tegretol, Tegretol XR Carbatrol) and phenobarbital can cause folic acid deficiency by interfering with its absorption.

Folic acid rich foods

It is necessary to know what foods contain folic acid to make sure you incorporate these food sources high in folic acid in your everyday pregnancy diet.

However, research shows that the body absorbs folic acid from supplements much better than the folate that occurs naturally in foods.

Again, foods can lose their folate content during storage or by cooking. Eating folate-rich foods, therefore, may not be the answer to your daily requirement.

Supplements and fortified foods become important for your daily need of folic acid.

Stir your fortified cereals well with milk and don’t forget to polish off the milk that settles down at the bottom after you have finished. All nutrients that fortify your cereals tend to settle down at the bottom with the milk.

Vegetables rich in folic acid

  • Green leafy vegetables including spinach
  • Lentils
  • Asparagus
  • Broccoli
  • Green beans
  • Black-eyed peas
  • Okra
  • Navy, pinto and garbanzo beans

Grains

Enriched and fortified whole grain and cereal products such as flour, pasta, and rice.

Fruits rich in folic acid

  • Papaya
  • Bananas
  • Orange and tomato juice
  • Strawberries
  • Pineapples

Nuts

  • almonds
  • cashew nuts
  • peanuts
  • walnut
  • sesame seeds.

Poultry, Meat, and Fish

  • Chicken and beef liver
  • Eggs
  • Canned salmon
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