Folic acid

Folic acid is a critical supplement for women who are pregnant or trying to conceive. This article answers some questions about Folic acid.

Why do I need folic acid?

Studies show that  folic acid deficiency during the first 3 months of pregnancy can cause serious birth defects of the spine and the brain, called Neural Tube Defects (NTD) like Spina Bifida etc.¹  It has been found that taking folic acid supplements daily, along with a diet containing foods rich in folic acid can help prevent these birth defects².

The risk of these birth defects are in the very begining of pregnancy and by the time women realize their pregnancy (typically after 3-5 weeks after conception), it might be too late.  So, to be safe, it is recommended that women wishing to conceive start taking folic acid supplements before conception.

So, women preparing for conception should start taking folic acid supplement containing atleast 400 micrograms daily (or as recommended by your doctor), at least 2 months before they intend to conceive. In cases of previous births with birth defects or diabetes or if you take epileptic drugs, a higher dose  maybe recommended by your doctor. In these cases, you should seek advise form your doctor before trying to conceive.

What is folic acid?

Folic acid is a B-vitamin that the a woman's body needs to make healthy new cells for both her own body and the baby. Scientists are not sure how folic acid works to prevent birth defects, but they do know that it is needed for making the cells that will form a baby’s brain, spine, organs, skin, and bones.

Folic acid can be found in...

Other than the supplements, foods rich in folic acid are

• Spinach, Palak, Pasalai keerai, Palang sag
• Eggs
• Liver (Goat and Sheep)

Is it necessary to take a folic acid supplement? Can't we get the dosage in regular food?

A number of foods have naturally occurring folic acid but the proportion is moderate and a large quantity of the food has to be consumed to reach the recommended dietary allowance of folic acid. Therefore, pregnant Indian women should primarily rely on the extra supplementation and not just on diet.

Can you exceed the folic acid dosage? Will that be harmful?

For most women, consuming more than 1,000 micrograms of folic acid daily is of no benefit. Unless their doctor advises them to take more, Indian women should limit the amount they take to 1,000 micrograms a day.

What are Neural Tube Defects and other birth defects caused by folic acid deficiency?

Neural tube defects (NTDs) are major birth defects of a baby’s brain or spine. They happen when the neural tube (that later turns into the brain and spine) doesn’t form properly, and the baby’s brain or spine is damaged. This happens within the first few weeks a woman is pregnant, often before a woman knows that she is pregnant.

The two most common NTDs are spina bifida and anencephaly. These birth defects can cause lifelong disability or death.

Spina Bifida (the most common type of NTD) occurs when the spine and back bones do not close all the way resulting in the spinal cord sticking out. Some of the problems these kids face is lack of lower limb mobility, loss of bowel and bladder control, learning disabilities etc. Most children born with spina bifida live full lives, but they often have lifelong disabilities and need many surgeries.

Anencephaly is an NTD, that results in major portions of the brain, skull and scalp missing. A baby born with anencephaly is usually blind, deaf, unconscious, and unable to feel pain.

How prevalent are Neural Tube Defects?

In India, the prevalence of NTDs is approximately 3 to 4 per 1000 live births¹. In the United States it is approximately 1 per 1000 live births.

Are there any other uses of folic acid for the growing embryo?

There is some research suggesting that folic acid may reduce the incidence of recurrent miscarriage, preterm delivery and low birth weight as well. Folic acid may also play a role in protecting against other birth defects, as well as some forms of cancer and heart disease.

1. Hibbard ED, Smithells RW. Folic acid metabolism and human embryopathy. Lancet 1965; 1: 1254 via Hema Gupta, Piyush Gupta "Neural Tube Defects and Folic Acid", Indian Pediatrics 2004; 41:577-586

2. Czeizel, AE, Dudas, I "Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation", N Engl J Med 1992 327: 1832-1835

3. Verma IC, "Burden of genetic disorders in India. Indian J Pediatr 2000; 67: 893-898 via Hema Gupta, Piyush Gupta "Neural Tube Defects and Folic Acid", Indian Pediatrics 2004; 41:577-586