Women who just learned the happiest phase of their lifetime – ‘pregnancy,’ will be at the top of the world. And they want to start getting health in the way they consume their foods and follow all that precisely so that the fetus can grow and develop normally without any negative outcomes. Women are also advised with supplementation of certain micronutrients to support their pregnancy from the beginning of the phase. The most important of these micronutrients is ‘Folate/Folic acid’.
Let’s understand about this micronutrient – ‘Folic acid or Vitamin B9’
Folate / Folic acid
Folate is the natural form of folic acid, which is also called as ‘Vitamin B9’. It is a water-soluble vitamin. It is present in foods such as leafy green vegetables, citrus fruits like oranges, and yeast extracts. Some foods such as breads and flours are fortified with folic acid (synthetic form of folate). Natural form folate is unstable and have less bioavailability (poorly absorbed by the body) whereas synthetic form/supplements is the folic acid that is absorbed well.
It is important in the formation of genetic material, cell multiplication and rapid growth during the embryonic and fetal stages of pregnancy.
Risk of deficiency in pregnancy
The most common risk of folate deficiency is the ‘Neural tube defect’ (NTDs) and also increased occurrence or recurrence of NTDs in further pregnancies.
Neural tube defects are the birth defects of the brain (anencephaly) and spine (spina bifida). This is due to the not closing of the neural tube overlying the developing embryonic brain and spinal cord. This closure occurs by 28 days, which the time when most women know about their pregnancy and it would be late to supplement with folic acid.
Folic acid supplementation are not effective if they begin the intake after 28 days of formation of embryo as by that time the neural tube development or closure will be completed (refer the pic). It is important to consume foods rich in folate along with supplementation of folic acid and maintain the nutrient adequacy in the maternal tissues and avoid deficiency.
The deficiency is measured by the increased levels of cysteine (folic acid metabolite). Many studies had shown that increasing the folic acid supplementation preconception phase would help with avoiding neural tube defects, and also help with unplanned pregnancies.
Recommended daily allowances (RDA)
To know the total folate derived from both dietary folate and supplemental folic acid, dietay folate equivalents (DFE) is a common way to express.
The RDA of folate for non-pregnant women is 400 µg/day DFE. During the pre-conception and conception, the folic acid recommendations are 600 µg/day DFE according to IOM (Institute of Medicine). According to US Preventive Task Force (USPTF), it is recommended that women who are planning or capable of pregnancy should take a daily dose of 400 - 800 µg/day of folic acid.
The requirements during pregnancy increase due to the demand in the making of genetic material (DNA), RNA, amino acids and other compounds for both fetal and maternal tissue growth. There is no upper tolerable level or limit for folic acid intake, as no toxicity is observed. Yet, recommended allowance should be followed to avoid any complication.
Conclusion
It is of utmost importance to start with folic acid supplementation long before the start of pregnancy (preconception) so as the maternal tissue have adequate levels to transport to the growing fetus to avoid the neural tube defects (NTD).
References
- De-Regil, L. M. et al. (2010) ‘Effects and safety of periconceptional folate supplementation for preventing birth defects’, in Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. doi: 10.1002/14651858.cd007950.pub2.
- Dean, S. V. et al. (2014) ‘Preconception care: Nutritional risks and interventions’, Reproductive Health. BioMed Central Ltd., p. S3. doi: 10.1186/1742-4755-11-S3-S3.
- Mousa, A., Naqash, A. and Lim, S. (2019) ‘Macronutrient and Micronutrient Intake during Pregnancy: An Overview of Recent Evidence’, Nutrients, 11(2). doi: 10.3390/NU11020443.
- Simpson, J. L. et al. (2010) ‘Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficiency or excess. Part I – Folate, Vitamin B12, Vitamin B6’, The Journal of Maternal-Fetal & Neonatal Medicine, 23(12), pp. 1323–1343. doi: 10.3109/14767051003678234.
Parisi, F. et al. (2018) ‘Micronutrient supplementation in pregnancy: Who, what and how much?’, https://doi.org/10.1177/1753495X18769213, 12(1), pp. 5–13. doi: 10.1177/1753495X18769213.
