Why Pregnant Women Should Consider Taking Folic Acid

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If you’re pregnant or trying to become pregnant, you’re likely to get a lot of advice about what you should be doing to keep yourself and your baby healthy. People will tell you to exercise a lot or not exercise at all, drink tons of tea or stop eating bread, and all sorts of other tips. All of this advice is well-intentioned but much of it isn’t backed by evidence. However, there’s at least one piece of advice that’s worth considering seriously: taking folic acid. What is it and why does it matter?

What Is Folic Acid?

Folic acid is a type of B vitamin that is found in much of the food we eat. You’ll find it in cereals, leafy vegetables like spinach, beans, mushrooms, organ meat such as kidney, and many fruits. You can also find it in many Vitamin B supplements. When you take folic acid, it increases the level of folate in your blood. Folate is good for your cardiovascular health because it reduces the level of homocysteine in your blood. Homocysteine is a type of amino acid that causes inflammation of the blood vessels, leading to blood clots, heart attacks, and strokes. Low folate can cause anemia and some studies have also linked healthy folate levels to a decrease in the risk of cancer and certain psychiatric illnesses. In other words, it’s important to get enough folic acid in your diet.

Folic Acid And Birth Defects

While you’re pregnant, your little one is going to go through a lot of changes. During the course of 40 weeks, your baby will grow from a single cell to a fully-formed human. That’s a very complicated process. Most babies develop normally but some, unfortunately, develop serious birth defects.

Folic acid has been found to help prevent a serious developmental issue: neural tube defects.

The neural tube is the structure that eventually develops into the baby’s spinal cord and brain. It starts as a little groove down one side of the cluster of cells. That groove eventually deepens and closes over to create a full tube in which the spinal cord and brain grow. A neural tube defect occurs when the rube fails to close completely. This causes spina bifida or closed neural tube defects.

Spina Bifida

There are a number of different types of spina bifida. If the spinal cord and meninges (the tissues that surround the spinal cord) are healthy and in the correct position but the vertebrae aren’t fully formed, it’s called spina bifida occulta. This form is typically mild and causes no side effects other than a dark or hairy patch over the area where the spine isn’t completely closed. Spina bifida cystica is a more serious condition in which the meninges and spinal fluid bulge out of the opening to form a meningocele. In very severe cases, the spinal cord itself bulges out as well, forming a myelomeningocele. The spinal cord may fuse to the damaged skin and bone around the opening, causing a condition called tethered spinal cord. The cord will stretch as the child grows, which can cause damage.These types of spina bifida are much more dangerous; they require surgery and the child is likely to suffer some disability.

Closed Neural Tube Defects

Closed neural tube defects are closely related to spina bifida. They occur when the vertebrae aren’t fully formed and the spinal cord and meninges are damaged or compromised. For example, the spinal cord may fuse to the skin covering the gap in the spine. A tethered spinal cord can cause permanent damage as the baby grows, so the spinal cord must be separated from the other tissue so it can float freely in the spinal canal. Closed neural tube defects vary in severity; some will have few or no symptoms while others may cause partial paralysis of the body below the opening in the spine.

Other Neural Tube Defects

Neural tube defects don’t just affect the spinal cord – they can also affect the baby’s brain. If the neural tube fails to close at the end rather than somewhere in the middle, the baby’s brain may not develop at all. That’s called anencephaly and is fatal. In other cases, the brain may form incorrectly, causing porencephaly or hydranencephaly, where part of the brain is replaced by fluid-filled sacs. These conditions may be fatal or may cause serious cognitive disabilities.

Taking Folic Acid Before And During Pregnancy

Neural tube defects occur very early in pregnancy – often before you even know you’re pregnant. That means it’s important to get enough folic acid if you may become pregnant. Experts recommend getting at least 400-800 micrograms of folic acid every day.

You’ll need to work with your doctor to determine what dose is right for you. If either parent has a neural tube defect or a family member with a neural tube defect, your doctor may recommend a much higher dose of folic acid. You may need to take a higher or lower dose if you’re taking certain medications for epilepsy, diabetes, lupus, inflammatory bowel disease, or rheumatoid arthritis or if you drink more than one alcoholic beverage per day. You may also need a different dose if you suffer from asthma, sickle cell disease, celiac disease, kidney disease, or liver disease.

Genetic Concerns

Your body processes folic acid into methylfolate through a process called methylation. Methylation in your body is regulated by the methylenetetrahydrofolate reductase (MTHFR) gene. You have two copies of this gene – one from each parent. Mutations of the MTHFR gene can affect your ability to process folic acid. If just one of your copies of MTHFR has a mutation, it’s called heterozygous and it won’t affect you. If both copies have mutations, it’s called homozygous and may impair your body’s ability to process folic acid.

There are two main types of MTHFR mutation: C677T and A1298C. Among other things, these mutations can increase your likelihood of blood clots and other cardiovascular issues. These issues can affect both you and the child. For example, blood clots in the umbilical cord can deprive your little one of needed oxygen and cause brain damage.

There are genetic tests for the two most common mutations, but they won’t necessarily tell you what you need to know. Even if you have a homozygous MTHFR mutation, it may not affect your ability to convert folic acid into the methylfolate your body needs. In addition, genetic testing can be expensive and may not be covered by your insurance. Testing for elevated homocysteine levels is simpler and can give you and your doctor a better sense of whether there may be a problem.

In general, testing for MTHFR mutations and homocysteine irregularities is not part of the standard suite of tests administered during pregnancy. Your doctor may only do the tests if you’ve had previous miscarriages or other issues. If you have a family history of MTHFR mutation, talk to your doctor about whether you should be tested and what your options are for avoiding complications.

Where To Get Folic Acid

As described above, folic acid is found in many of the foods you eat every day. Breakfast cereals are commonly fortified with extra folic acid, so check the nutrition facts to see how much is in each serving. The label may say “folate” rather than folic acid, as the food industry tends to use these labels interchangeably. Your doctor may recommend that you take a multivitamin to ensure that you’re getting enough, since it’s harder for the body to absorb naturally-occurring folic acid than man-made folic acid.

You may need to continue taking a folic acid supplement if you decide to breastfeed your little one in order to maintain a healthy level in your blood.

Depending on your unique health needs, your doctor may recommend that you take folate rather than folic acid. It’s a different form of the nutrient that may be easier for some people to process.

Talk To Your Doctor

Everyone is different and will have different nutritional needs during pregnancy. Talk to your doctor about your health and your medical history to determine what’s best for you. Your nutritional needs may change over the course of your pregnancy, so work with your doctor to update your supplements and diet as your little one grows.

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