Folic Acid: What Every Expectant Mother Should Take
By: Dr. Obikoya

Folic acid, also called Pteroylglutamic Acid, Folate, or Folacin, is one of the vitamins of the B complex that is essential for a variety of metabolic processes in our body. In humans, folic acid is necessary for the synthesis of nucleic acids and the formation of heme, the pigmented, iron-carrying component of the hemoglobin in red blood cells.

A diet deficient in folic acid can impair the maturation of young red blood cells, resulting in folic-acid-deficiency anemia. Pregnant women with an insufficient intake of folic acid are more likely to give birth prematurely or to deliver babies with low birth weight or with neural tube defects. Recent research has shown that adequate amounts of folic acid can prevent up to half, or more of these birth defects, if women start taking folic acid supplements shortly before conception.

Folic acid is necessary for growth and cellular repair, since it is a critical component of DNA and RNA as well as essential for the formation and maturation of red blood cells. Folic acid deficiency is one of the most common of all vitamin deficiencies. Although it occurs in both males and females, folic acid deficiency anemia most often affects women over 30. It becomes increasingly common as age impedes the body's ability to absorb folic acid, a water-soluble vitamin that is manufactured by intestinal bacteria and stored for a short time in the liver.

A healthy adult needs at least 400 mcg of folic acid every day. Requirements at least double during pregnancy, and increase by 50% when a woman is breastfeeding. The average American diet, high in fats, sugar, and white flour, provides about 200 mcg of folic acid, approximately the amount needed to maintain tissue stores of the substance for six to nine months before a deficiency develops.

Most of the folic acid in foods (with the exception of the folic acid added to enriched flour and breakfast cereals) occurs as folate. Folate is only about half as available for the body to use as is the folic acid in less expensive pills and supplements. Folate also is easily destroyed by sunlight, overcooking, or the storing of foods at room temperature for an extended period of time.

Folic acid deficiency usually results from a diet lacking in foods with high folic acid content, or from the body's inability to digest foods or absorb foods having high folic acid content. Other factors that increase the risk of developing folic acid deficiency anemia are: age, alcoholism, birth-control pills, anticonvulsant therapy, sulfa antibiotics, and certain other medications, illness, smoking, and stress.

Fatigue is often the first sign of folic acid deficiency anemia. Other symptoms include: anorexia nervosa, pale skin, rapid heart beat, sore and inflamed tongue, weakness, and weight loss.

Although adequate folic acid intake usually cures this condition in about three weeks, folic acid deficiency anemia can make patients infertile or more susceptible to infection. Severe deficiencies can result in congestive heart failure. In addition to eating raw or lightly cooked vegetables every day to help maintain normal folic acid levels, it is also necessary to take a folic acid supplement containing at least 400 mcg of this vitamin. Because folic acid deficiency can cause birth defects, all women of childbearing age who can become pregnant should consume at least 400 mcg of folic acid daily. In fact, women who take folic acid when trying to conceive have been shown to have a lower risk of a pregnancy affected by neural tube defects.1 The UK Department of Health has recommended that folic acid is taken by all women planning a pregnancy.2, 3

A good rule of thumb if you are pregnant is: Get your folic acid by eating foods high in folate, such as broccoli and dark leafy greens, and taking a daily supplement that contains at least 400 micrograms of folic acid before you become pregnant, you can help protect your baby against neural-tube defects such as spina bifida. During pregnancy, increase your daily intake to 600 micrograms.

For years, young women have been advised to take folic acid supplements before they become pregnant and to continue taking them in the early stage of pregnancy. The practice is known to reduce the odds of having a baby with a neural-tube defect. The persistent concern that folic acid supplements during the pregnancy might increase the risk of miscarriage has been dismissed by a study published in New England Journal of Medicine.

A team of researchers from the U.S. and China collaborated on this study of more than 23,000 Chinese women who did and did not take folic acid supplements before and during the first trimester of pregnancy. The miscarriage rate was the same (9%) for both groups. Folic acid does not increase the rate of miscarriages.

Another study of nearly 250,000 Chinese women has found that taking folic acid to reduce risk of neural tube birth defects does not increase a woman's chance of giving birth to twins, according to a Jan 27, 2003, news release from the Centers for Disease Control and Prevention. Many studies have shown that folic acid reduces the incidence of spina bifida and other neural tube defects; however, some researchers have questioned whether multiple births could be associated with folic acid consumption during pregnancy.

According to the release, the new study found no link between folic acid intake and multiple births. There was no difference in twin birth rates for women in the study who took 400 mcg of folic acid daily before conception and during early pregnancy compared to those who took no folic acid.

This study focused on women who had participated in a previous study of neural tube birth and defects and who took one 400 mcg folic acid pill per day. The study found no link between taking folic acid and having twins.

A woman who is pregnant should have regular medical checkups, and take a good prenatal vitamin that contains folic acid.

References
1. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the MRC vitamin study. Lancet 1991; 338: 132-7

2. Expert Advisory Group. Folic acid and the prevention of neural tube defects London: Department of Health, 1992.

3. Sutcliffe M, Schorah CJ, Perry A, Wild J. Prevention of neural tube defects. Lancet 1993; 342:1174.

4. New England Journal of Medicine (9/8/01).

5. Gastrointestinal Disorders: Malabsorption Syndromes." The Meck Page. 13 Apr. 1998 http://www.merck.com

6. News release, Atlanta: Centers for Disease Control and Prevention, Jan 27, 2003) http:/www.cdc.gov/od/oc /media/pressrel/r030127.htm (accessed 10 Feb 2003).