Folic Acid and Pregnancy
Background: Folic acid is one of the B group of vitamins (B9). It plays an important part in everyone’s diet, as it is responsible for cell growth and development. However, it becomes even more important for women prior to, and during the early stages of, pregnancy. Folic acid is vital to support the healthy development of a baby’s brain and spinal cord. Before you are even aware that you’re pregnant, your baby’s brain and spinal cord are already forming. By having enough folic acid in your blood at this important time, you help to ensure that they develop properly.
The U.S. Public Health Service and CDC recommend that all women of childbearing age should consume 0.4 mg (400 micrograms) of folic acid that helps to prevent serious birth defects affecting the brain and spinal cord. These are known as neural tube defects (NTDs) such as Spina Bifida (in which the neural tube fails to close properly at the lower end causing paralysis or loss of bowel and bladder control) and Anencephaly (in which brain and skull of a baby fail to form fully).
Among many other countries, the highest burden of NTDs is found in India – 5 per 1000 births. This rate is very high when compared to the NTDs rate in USA, Canada and Australia – 10 per 10,000 births (Source: http://www.indiastudychannel.com/forum/35629-FOLIC-ACID-DEFICIENCY-IN-INDIA.aspx). Such defects can cause infant mortality and spontaneous abortion. We, Indians, need to be more conscious about folic acid deficiency since it affects our future generations.
Symptoms:
If you don’t have enough folate in your diet, you may end up with a folate deficiency. Deficiency may also occur if you have a disease or genetic mutation that prevents your body from absorbing or converting folate into its usable form. Alcohol also interferes with folate absorption. It also increases folate excretion through the urine. Folate deficiency can cause anemia. Anemia is a condition in which you have too few RBCs. Anemia can deprive your tissues of oxygen it needs because RBCs carry the oxygen. This may affect their function.
Any kind of anemia can cause problems like:
• Fatigue
• Lack of energy
• Feeling short of breath
• Headache
• Pale skin
• Racing heart
• Weight loss or not feeling hungry
• Ringing in your ears
If anemia is caused by not having enough folate in your body, you may also notice the following (along with the symptoms mentioned above):
• Reduced sense of taste
• Diarrhea
• Pins and needles feeling or numbness in your hands and feet
• Muscle weakness
• Depression
Diagnosis:
NTDs are usually diagnosed before the infant is born, through laboratory or imaging tests.
Prenatal laboratory tests include:
• Triple screen blood test: One part of the triple screen blood test is a test for an elevated level of alpha-fetoprotein (AFP), which is associated with a higher risk of neural tube defects. The two other parts of the “triple screen” involve testing for human chorionic gonadotropin (hCG) and estriol. This test is generally done during the second trimester.
• Amniotic fluid test: Testing of amniotic fluid may also show a high level of AFP, as well as high levels of acetylcholinesterase. Healthcare providers might conduct this test to confirm high levels of AFP seen in the triple screen blood test. The amniotic fluid also can be tested for chromosomal abnormalities, which might be the cause of the abnormal AFP level.
Prenatal ultrasound imaging usually detects almost all types of neural tube defects.
Treatment:
Treatment involves increasing the dietary intake of folate. A folate supplement can also be recommended. Those with a genetic mutation (MTHFR) that affects folate absorption need to take methylated folate in order to avoid deficiency.
Folate is frequently combined with other B vitamins in supplements. These are sometimes called vitamin B complexes. They are given to the patients suffering from folate deficiency.
Prevention:
Getting enough folic acid before and during pregnancy prevents most NTDs. Consumption of foods rich in folate is the best way to prevent folic acid deficiency. Green leafy vegetables such as spinach and broccoli are good sources of folate. Banana, lima beans, liver, yeast, citrus fruits, lettuce, egg yolk, cabbage, soybean and whole grains are also good sources of folic acid. It is also available in the form of dietary supplements as well as in the form of medicines. Folates, being water soluble, are not stored in the body and the excess amount of vitamin will be eliminated daily. Hence, it is mandatory to meet the recommended allowances regularly.
When you prepare food, try to ‘lightly steam’ or ‘lightly cook’ the food as this helps keep more folate content in the cooked foods, thereby helping you prevent folic acid deficiency.
Pregnant women should completely avoid alcohol, and everyone else with a folate deficiency should decrease their alcohol intake.
Author
Dr. Saman Ahmad, Ph.D ( Clinical Biochemistry), J.N. Medical College, Aligarh Muslim University, India.
November 10, 2017
Reference:
J Obstet Gynaecol India. 2014 Oct; 64(5): 328–331.
Indian Perspective on Clinical Aspects, Usage, and Guidelines of Folic Acid
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199433/