Folic Acid in Pregnancy

Folic acid and folate, are forms of a water-soluble B vitamin that helps the body make healthy new cells. Women who are pregnant or might become pregnant take folic acid to prevent miscarriage and birth defects. Folic Acid is used to make the extra blood your body needs during pregnancy. According to the US Preventative Task Force, all women of childbearing age should consume 600 – 800 micrograms (0.6 – 0.8 milligrams) of folic acid a day.

When should I start taking folic acid?

You should start taking folic acid prior to getting pregnant even if you are not trying to conceive. Neural tube defects usually develop in the first 28 days of pregnancy, often before a woman even knows that she is pregnant.

If you find you are pregnant and have not been taking folic acid, you should start now to help prevent any neural defects in the first three months of pregnancy.

What’s the difference between Folic Acid and Folate?

People often use the two interchangeably as they are both forms of vitamin B9 but in fact there is an important difference. Folic acid is the synthesized version that is commonly used in processed foods and supplements. Folate can be found in whole foods such as leafy vegetables, eggs, and citrus fruits. Unfortunately, a large percentage of women (up to 60%) have a defect in their MTHFR gene that doesn’t allow them to properly convert synthetic folic acid into active methylfolate. As such women taking folic acid may not be absorbing their B vitamins as expected. For this reason it’s preferable to take folate either from whole food sources or supplements that containing the natural form of active folate instead of synthesized folic acid whenever possible.

What are the risks of not taking folic acid?

The absence of this important nutrient increases the possibility of a neural tube defect (a defect in the development of the spinal cord).

  • Spina bifida is a condition in which the spinal cord is exposed. If the vertebrae (bones of the spinal column) surrounding the spinal cord do not close properly during the first 28 days after fertilization, the cord or spinal fluid bulge through, usually in the lower back.
  • Anencephaly is the severe underdevelopment of the brain.

What foods contain folic acid?

Approximately half of all pregnancies are unplanned, so the U.S. Food and Drug Administration has taken steps to fortify certain foods so that all women of childbearing age receive a daily dose of folic acid.

The following foods can help you obtain your recommended amount:

  • Leafy green vegetables, such as spinach
  • Citrus fruits, such as orange juice
  • Beans, peas and nuts
  • Enriched bread, cereals and other grain products
  • Rice
  • Pasta

A daily vitamin with folic acid may be suggested by your health care provider since the foods listed above may not contain enough folic acid to meet the daily requirement.

How do I know if I am at risk of having a baby with neural defects, and how can I prevent this from happening?

Women who are at greatest risk are those that have had a previous pregnancy that involved a neural defect. Women who are not eating a balanced diet that includes folic acid are also at risk.
The best way to prevent neural defects is to take the recommended 600 – 800 micrograms (0.6 – 0.8 milligrams) of folic acid daily for one month before conception and during the first three months of pregnancy. The daily amount should not exceed 1000 micrograms (1.0 milligrams).

Multivitamins that include folic acid should only be used as a supplement under the supervision of your health care provider.

How are neural tube defects diagnosed?

Neural tube defects are detected through an alpha-fetoprotein test (AFP). AFP is a blood test administered at 16-18 weeks gestation.  The test measures alpha-fetoprotein, a substance produced by the fetus and secreted into the amniotic fluid.
AFP is also found in the mother’s blood. The level of AFP in the mother’s blood peaks at about 30-32 weeks.  Abnormally high amounts of AFP may indicate that a baby has a neural tube defect.

What are other reasons for an elevated AFP?

An elevated AFP could mean the mother is carrying twins or that there is a problem with the placenta. Women with diabetes or liver disease may also have an elevated AFP level.

However, an elevated AFP could also mean that there are birth defects present such as severe kidney disease, liver disease, esophageal or intestinal blockage, Down Syndrome, urinary obstruction, or osteogenesis imperfecta (fragility of the baby’s bones).

If I have an elevated AFP, what additional tests are available?

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