Why do I need to take folic acid before and during pregnancy?
Folic acid is a B-vitamin that is essential for normal neural tube closure and development in the fetus.
Very early in pregnancy, the tiny “neural plate” that will become the brain, spinal cord, and nervous system starts to fold in from the sides to become the “neural tube,” which closes completely by 28 days of pregnancy. If there is a gap in the tube at the line where it closes, there will be neural tube defects in the baby. These range from mild or hidden spina bifida, where part of the spinal cord protrudes slightly from the bony spine, to open spina bifida or meningomyelocele, where it protrudes through the back, to anencephaly, which is the absence of a brain. Obviously, these can be severe defects; anencephaly is inevitably fatal, if not before the baby is born, then shortly after. These defects occur in about 4.5 to 5 live births per thousand in the British Isles, and about 1.5 to 2.0 live births per thousand in the United States, with lower rates in black and Asian mothers.
According to a survey conducted by the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Community Health, approximately 70% of women of reproductive age may not understand the importance of adequate dietary folate in preventing neural tube defects (NTDs) in offspring. The survey also found that only 42.4% of women reported taking a multivitamin or folic acid supplement daily. The findings are published in the March 16th, 2001 issue of the Morbidity and Mortality Weekly Report.
A total of 739 Michigan women of reproductive age (18 to 44 years) answered questions about multivitamin use and folic acid knowledge. Women most likely to be knowledgeable about folic acid use were college graduates (42.2%), aged 25 to 29 years (39.8%), former smokers (37.0%), married (35.8%), those who ate five or more fruits and vegetables a day (34.9%), not overweight (31.9%), and white (31.5%). By and large, the same categories were most likely to take multivitamins.
Women who were only high school graduates, current smokers, and unmarried were less likely to have correct knowledge of folic acid use, according to the CDC. Similar groups also were less likely to use a multivitamin. “Two thirds of women in the US do not get enough folic acid,” Dr. Lockett said. “Because low education level was associated with low folic acid knowledge, a continued educational effort from medical and nutritional professionals is needed to increase knowledge and support behavior change,” the CDC researchers note. (MMWR Morb Mortal Wkly Rep 2001;50:185-189.)
Folic acid supplements are cheap and should be taken by all women of childbearing age. This vitamin also works in conjunction with Vitamin B12 to metabolize, or break down, fats and proteins so they can be used for energy. Recently, it has been shown to be important in preventing the conversion from “good” to “bad” cholesterol, so it is helpful in preventing arteriosclerosis and heart disease. All in all, we should probably all be taking at least 400 mcg of folic acid every day, pregnant or not.
The March of Dimes lists foods that are high in folic acid:
“Some flour, breads, cereals and pasta have folic acid added to them. Look for “fortified” or “enriched” on the package to know if the product has folic acid in it. Even if you eat fortified or enriched foods, be sure to keep taking your multivitamin or prenatal vitamin with folic acid.
You also can get folic acid from some fruits and vegetables. When folic acid is naturally in a food, it’s called folate. Foods that are good sources of folate are:
- Beans, like lentils, pinto beans and black beans
- Leafy green vegetables, like spinach and Romaine lettuce
- Peanuts (But don’t eat them if you have a peanut allergy)
- Citrus fruits, like oranges and grapefruit
- Orange juice (From concentrate is best)”
Other sources list brussels sprouts and avocado as very good sources of folate, so try these as well!