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Folic Acid - An essential nutrient during pregnancy

What could be more important to an expectant mother than giving birth to a healthy baby? One of the best ways to guarantee that outcome is for women to supplement with folic acid during the first four weeks of their pregnancy. This simple precaution can reduce the risk of the baby contracting a serious brain and spinal cord defect by over 70%.

Folic acid (one of the B group vitamins) is the synthetic form of naturally occurring folate and is essential for cell replication and growth, hence its importance to the early development of the embryo. One of the most common types of defects that can occur in the first month of fetal development are those involving incomplete closure of the neural tube—which eventually becomes the child’s brain and spinal cord. Spina bifida, which can lead to paralysis, is perhaps the best known defect of this type. Numerous research studies have directly linked folate deficiency with these birth defects.

For example, a study published in the Lancet (1991; 338(8760):131-7) linked low folate levels during pregnancy with both low birth weight and increased numbers of neural tube defects. The authors concluded “women who were at high risk of giving birth to babies with neural tube defects were able to lower their risk by 72% by taking folic acid supplements prior to and during pregnancy.” Other studies have correlated low folate levels with birth defects of the heart, urinary tract, and facial structure. Preliminary research (American Journal of Clinical Nutrition, Vol. 70, No. 4, 495-501, October 1999) has shown a possible link between folic acid and Down syndrome.

Apart from birth defects, folate deficiency during pregnancy can lead to anemia in the mother as well as birth complications, such as premature separation of the placenta from the uterine wall and the delivery of underweight babies.

A woman’s need for folate increases during pregnancy; so that a person who has been able to maintain a high enough level from their regular diet before pregnancy may no longer be able to do so without supplementation. A further complication is that folate that occurs naturally in food is considerably less bioavailable than the synthetically produced folic acid.

Folic acid is water soluble, and therefore needs to be taken on a daily basis. It also requires time to build up in the body to optimal levels. Therefore, women wishing to fall pregnant should commence supplementation before conception, thus avoiding the buildup period and ensuring that the unborn child has adequate folic acid during the initial critical weeks of growth. For these reasons, and also because many pregnancies are unplanned, health professionals recommend that all women of childbearing age supplement with 400mcg of folic acid per day.

Such is the acceptance of the fact that sufficient folate is necessary for good health that, in 1996, the FDA introduced a requirement that all enriched flour, rice, pasta, cornmeal, and other grain products be fortified with 140mcg per 100 grams. However, the evidence (e.g., Lancet 1999;354:2168) suggests that, unless the level of fortification is quadrupled, women will still need additional supplementation if they are to be sure of avoiding neural tube defects and other problems.