Folic Acid in Pregnancy: How important is Folic Acid to a Pregnant woman?
Folic Acid in Pregnancy: Overall, it appears to be quite straightforward; we’ve been taking vitamins since infancy, and pregnancy sounds like a crucial time to take more supplements.
But supplementation is only one aspect of folate’s significance in pregnancy.
It was not unusual for newborns to be born with parts of their brains exposed or incompletely covered by skeletal structures until the 1990s. The disease that occurs during the very first stages of pregnancy is known as a neural tube defect (NTD) in this scenario.
In the 1960s, it was suggested that folic acid deficiency may increase the incidence of NTDs. A historical MRC Vitamin Group Study from 1991 that was published in the Lancet included information from over a thousand women who had previously had babies with NTDs. According to scientists, folic acid intake reduced the incidence of NTD by 72% throughout the current pregnancy.
For public health, this revelation was groundbreaking. Despite how simple the remedy may seem, countries without folic acid supplementation still have 0.5 to 2 neural tube abnormalities per 1000 live births.
Folic Acid in Pregnancy:
Uncompleted brain tube closure is a neural tube defect.
Neural tube defects
Neuronal structures fold and fuse in the centre to create a tube during development (embryo development). Neglect of this process results in neural tube defects. NTDs come in a variety of shapes depending on where the partial closure occurred:
Anencephaly. The cranial brain (brain within the skull), which is not formed if the lesion is on the “upper” half of the embryo (future head), does not develop. These infants’ heads only house the face; the remainder of the head, including the brain, is absent. Because of this abnormality, babies are unable to live beyond birth.
Spina bifida. The “lower” end of the embryo (the future sacrum) has an imperfect closure. As a result, the bone canal does not completely protect the end of the spinal brain. The aperture on the surface of the brain can change; in certain cases, the brain itself (myelomeningocele) or its protective coating (meningocele) can protrude through the spine’s hole. In the latter, which is more severe, damaged brain tissue and protruding nerves are present.
Daily folic acid supplementation prevents NTD risk
The Food and Nutrition Board advises singleton, pregnant women, to take 600 mcg of folic acid daily in addition to their normal dietary consumption. For twin pregnancies, this dose is 1000 mcg.
This preventative advice’s most important component is when to take supplements. It’s crucial to keep in mind that folic acid should not be started during pregnancy but rather before fertilization. But why is that so?
The conundrum makes sense if we consider the schedule of embryonic brain development and keep in mind the fundamentals of the menstrual cycle.
Within the first 18 to 28 days of fertilization, the brain tube closes. The likelihood of missing the tube formation period is quite high because fertilization takes place two weeks following the last menstrual cycle.
Most of the time, when couples discover pregnancy and are prescribed folic acid, this window has already passed.
Major health organizations recommend preconception folic acid supplementation
Folic acid supplements preconception.
The Food and Nutrition Board recommends:
| Type | Dosage |
| For all reproductive-aged women | 400 mcg |
| For breastfeeding women. | 500 mcg |
| For pregnant women | 600 mcg |
All women of reproductive age should take 400 mcg of folic acid daily as a supplement beginning one month before conception and continuing through the third trimester of pregnancy, according to the Centres for Disease Control and Prevention (CDC).
The likelihood of developing the pathology in subsequent pregnancies is increased in women who have already experienced an NTD. As a result, the CDC advises giving women with a history of NTD a high dose of folic acid (4000 mcg). Additionally, regardless of whether they intend to become pregnant, women of childbearing age with a history of NTD should receive 400 mcg of folic acid.
The 400 mcg prenatal supplementation is also recommended by the American College of Obstetricians and Gynaecologists (ACOG) in order to meet the daily need of 600 mcg through food consumption.
Scientists want laws mandating fortification
Following the findings of the MRC Vitamin Group Study, there was optimism that vitamin supplementation could lower NTD frequencies worldwide. However, the majority of women either miss the window necessary for neural tube formation or disregard advice.
The FDA authorized the addition of synthetic folic acid to grain products, including flour, bread, rice, and pasta, in 1996. To address the issue more broadly, the USA and Canada implemented a required folic acid fortification program in 1998. Consuming grain products with folic acid added would help prevent missing the window for early pregnancy and lower the incidence of vitamin insufficiency.
A few years later, investigations from these nations revealed that, compared to the years without fortification, NTD frequency had dropped by 31% to 46%.
Fortification of grain products with folic acid is now required in up to 75 nations, 30 years after the beneficial data was first shown. 28 EU members are among the more than 100 nations that do not have a fortification policy that is required.
The potential adverse effects of folic acids, such as masking vitamin B12 deficient symptoms and increasing the risk of colon cancer, are the major cause of opposition to the programme.
Since the prophylactic effect of folic acid was demonstrated, the prevalence of NTD has remained steady in Europe, according to the EUROCAT (European Network for the Surveillance of congenital abnormalities).
Scientists from the Spina Bifida Prevention Centre at Emory University recently urged the World Health Assembly to pass a resolution mandating fortification across the board in a recent Lancet Global Health article. The fortification approach was recognised by the authors as a “safe, economically viable, and sustainable intervention” to avoid neural tube abnormalities. They also emphasised the fact that fortified goods have only been able to prevent 25% of all occurrences of avoidable anencephaly and spina bifida.
Resources:
The Lancet Global Health. Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid.
New England Journal of Medicine. Reduction in neural-tube defects after folic acid fortification in Canada.
European Commission EUROCAT. Folic Acid and Neural Tube Defects.
Annual Review of Neuroscience. Neural Tube Defects.
Center for Diseases Control and Prevention. Folic Acid Recommendations.
National Institues of Health. Folate.
