Why Taking Folic Acid is Essential Before and During Pregnancy - Virtua Article

Why Taking Folic Acid is Essential Before and During Pregnancy

By Rachel Kramer, MD, Ob/Gyn—Virtua Obstetrics & Gynecology

If there’s a possibility you could get pregnant (and that includes most women in late teens to mid-40s), you should be taking a daily folic acid supplement now. That’s because folic acid can decrease the risk of neural tube defects in a developing baby by 70%, according to research from the March of Dimes.

If having a baby isn’t in your immediate plans, it may not seem important to take folic acid now. But, to decrease the risk of neural tube defects, you have to supplement with 400 mcg (micrograms) of folic acid for at least 3 months before conception and for the entire first trimester. Very few women become pregnant exactly when they’ve planned, and most women I see during their first prenatal appointment have already missed the critical window for this supplementation.

What is the neural tube?

In a developing fetus, the neural tube is the part that becomes the brain and spine. It closes completely by the end of the 4th week after conception (which is around the time you’d test positive on a pregnancy test).

Neural tube defects occur when something goes wrong with that closure. Spina bifida is the most common neural tube defect. If the spinal cord doesn’t close completely, it can cause weakness, orthopedic abnormalities, or even paralysis of the lower limbs, along with bladder and bowel control issues, sexual function limitations, and many other problems. Neural tube defects also can affect the brain, which is usually a much more serious condition, and often fatal.

These defects are scary, but also preventable in many instances—and taking folic acid is the best known prevention method. While supplementation can help reduce risks, there are other controllable and non-controllable issues affecting women that still put them and their babies at a greater risk. These include:

  • BMI of 30 or more (this includes almost 40% of U.S. women)
  • Diabetes
  • Taking anti-convulsant medications (to prevent seizures or to treat a mental illness)
  • Hemoglobin disorder (like sickle-cell anemia)
  • Previous birth to a baby with a neural tube defect
  • A first-degree relative (sibling, parent) with a neural tube defect

Folic acid sources

Folic acid supplements are available without a prescription at drug stores, and should be taken once daily. There are also foods you can include in your diet to give these supplements a boost (you can’t take too much folic acid, as any amount that the body can’t use gets excreted during urination). Just know that diet alone will NOT provide enough folic acid to forego the need for a daily supplement.

Many processed carbohydrates have been enriched with folic acid including breads, breakfast cereals, cornmeal, flour, pasta, and some brands of white rice. Natural sources include beans, leafy greens, asparagus, broccoli, peanuts, and citrus fruits like oranges and grapefruits.

Choose a healthy diet and include some of these foods for good measure. But, do yourself (and your future baby) a favor and start a folic acid regimen today. 

Virtua's maternity care program offers many resources, classes and checklists to help you have a healthy pregnancy. 

Updated April 23, 2018

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