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Folic Acid During Preconception
Author: Dr. Anna Kaplan
Folic acid is a vitamin that is essential for good health. It is necessary for synthesis of DNA, the genetic blueprint of the cells, and also for normal cell growth. People who do not take in enough folic acid can wind up with not enough red blood cells, which is called anemia. Other problems can also occur, such as a decrease in appetite, weight loss, and diarrhea, as well as weakness and headaches, along with memory difficulties and irritability.
A woman with borderline or slightly low levels of folic acid may not have any symptoms, but will not have enough of the vitamin for a rapidly growing baby if she becomes pregnant. Without enough folic acid, babies can be born too early, too small, or with a condition called “a neural tube defect.”
A neural tube defect occurs when the neural tube, which makes up the brain and spinal column, does not develop normally in early pregnancy. This includes anencephaly, in which most of the brain is absent at birth, and is essentially always fatal. Another neural tube defect is called spina bifida. This means that that the spinal column has not completely closed and, therefore, is not protected as it should be by linings and bone. The spinal cord is then subject to damage, which leads to partial or complete paralysis of the newborn baby.
This part of fetal development occurs very early, before the first missed menstrual period. Since many women do not know they are pregnant during this time, it is recommended that all women of child-bearing age take supplemental folic acid. It is critical for women who are planning to get pregnant to take extra folate.
Folic acid occurs naturally in green leafy vegetables. In the United States, grains and cereals are fortified with the vitamin as well. Even so, many people do not get enough folic acid for their own needs, and a pregnant woman needs even more.
The U.S. Preventive Services Task Force suggests that women of childbearing age take 400 to 800 micrograms of folic acid a day. Women who have trouble absorbing vitamins because of intestinal problems such as gluten intolerance may need to take a higher dose. Women with epilepsy who are taking medication to prevent seizures may also need a larger amount of folic acid.
Women who have had a child with a neural tube defect are more likely to have another child with a similar problem. They are advised to take 4 milligrams of folic acid a day. Taking folic acid supplements reduces this risk by 70%.
Neural tube defects are estimated to occur in one out of every thousand pregnancies. Since the FDA started fortifying grains in the United States, the number has dropped by 26 to 50 percent.
There is also evidence that taking folic acid can reduce the risk that your baby will have a cleft lip and/or cleft palate.
When you are considering pregnancy, folic acid should be added to your daily routine. If you have a reason to think you are particularly low in the vitamin, you should discuss it with your doctor. There are tests to measure the folic acid level in your system that might be helpful in deciding how much you should take.
Think about how much folic you might get in a day, considering your cereal consumption as well as how much salad and other greens you eat. For most women, 400 to 800 micrograms is the right amount of supplemental folic acid a day before they become pregnant.
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