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Why are Folic Acid supplements needed in pregnancy?

prenatal vitamins. folic acid in pregnancy, first trimester

In recent times, more and more couples are having planned pregnancies. They are aware of the responsibility a pregnancy brings and plan it around their careers and other life priorities. There are a few things to keep in mind if planning to conceive. A visit to the family physician would be a good idea, along with a few basic tests to make sure you are ready to start trying for a pregnancy.

Starting supplementation with folic acid tablets is another important thing you need to do to ensure a healthy pregnancy. Few people are aware of this and mostly start the supplementation only after they miss their menstrual cycle and have a positive pregnancy test. By that time 6 – 8 weeks have already passed and the fetus has started developing. So the folic acid supplementation often gets missed in the initial phase. This can be avoided by starting on a supplement right when you decide to conceive.

So what is the big deal about Folic acid. Why is it so important during pregnancy?

Folic Acid, also called vitamin B9 is one of the 13 essential vitamins. It cannot be synthesized within the human body and must be obtained either through diet or supplementation. The form which is available naturally through diet is called folate while the synthetic form of this vitamin found in pharmaceutical supplements is called folic acid. Both of these need to be converted to the metabolically active form in the body called “L methyl folate” so that it can be utilized by the cells of our body. This is done by certain specialized enzymes in our body.

first 9 weeks of development of the fetus in utero. Neural tube defects. Folic acid supplementation.
Adapted from clevelandclinic website.

Folic Acid has a varied role to play in the processes of our body. During pregnancy it helps in the formation of DNA and also plays a key role in the development of the spinal cord and brain of the fetus.

A large part of this development happens within the first 6 to 9 weeks of gestation and the spinal cord of the fetus continues to grow at a slower pace throughout the rest of the pregnancy.

A deficiency of Folic Acid during pregnancy, especially in the first trimester can cause certain birth defects in the fetus called as Neural Tube defects. There are many types of neural tube defects, the most common ones are spina bifida and anencephaly. Some of the neural tube defects are not compatible with life, meaning it may cause a miscarriage or even a stillbirth later. But some neural tube defects are more subtle and can manifest in the newborn as paralysis, blindness, deafness, bowel or bladder problems, intellectual disability in childhood and even death. The gross defects can be detected through ultrasound during pregnancy but cannot be reversed. So prevention is the best.

The prevalence of neural tube defects in India is 5 per 1000 live births. This is much higher than the western countries. The prevalence is also higher in some states and rural areas going up to even 11 per 1000 live births. So as Indians, it is imperative that we take all steps to prevent these defects in our pregnancies.

In addition to preventing neural tube defects, there is evidence to show that folic acid prevents congenital heart diseases, cleft lip/palate disorders and helps in the normal development of the placenta. It also helps to prevent preterm labour in later part of pregnancy.

The recommended dosage of folic acid supplementation during pregnancy is 400 micrograms per day in addition to a balanced diet with folic acid rich foods. Foods such as dark leafy greens, broccoli, asparagus, nuts and seeds, eggs, beetroots, sweet potato, avocados, bananas, citrus fruits and lentils are rich in folic acid. A nutritious diet is very important during pregnancy. Supplements are not a replacement for a wholesome daily diet. They merely add to them.

With vitamin supplements sometimes there is concern about taking too much. Folic acid is a water soluble vitamin. This means that any excess folic acid does not remain in the body. It is removed through urine. There is no risk of toxicity with this vitamin unlike certain other vitamins that are fat soluble (Vitamins A, D , E , K) which can get accumulated in the body. This also means that there are no stored reserves of this vitamin in your body and you need to consume folic acid everyday to meet the daily requirements. That is the reason why daily supplementation is necessary during pregnancy.

Some women are at a higher risk of having babies with neural tube defects and they may require higher doses of supplementation with folic acid of 5mg/day beginning atleast 3 momths prior to conception. These are:

  • Women with a previous pregnancy with congenital defects

  • Women who have had unexplained recurrent miscarriages

  • Women with Diabetes

  • Women with vitamin B12 deficiency

  • Women with a family history of neural tube defects

  • Women who take antiseizure medications

  • Women who are obese

  • Women who had fever during the early phase of pregnancy

  • Cigarette smoking and alcohol consumption during pregnancy

  • Women who use recreational drugs or took opioid drugs during the initial phase of pregnancy

Make sure to mention any of these to your doctor if you are planning to conceive so he/she can advice accordingly. Folic acid supplements are easily available over the counter. The higher dosage supplements may require a prescription so speak to your doctor about this if you are planning a pregnancy.

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