What You Need to Know About Folic Acid

Today’s blog comes to us from Dr. Patrick Dawson, ob-gyn.

1. Why is folic acid during pregnancy important?

Folate (also known as folic acid) is important in cell growth and differentiation. A growing baby needs access to adequate folate to prevent certain birth defects. We know that women who are deficient in folic acid have an increased risk of having a baby with an open neural tube defect such as spina bifida or anencephaly. It is important to know, however, that there are many reasons for birth defects, and even with enough supplementation, we cannot prevent all problems.

2. If planning pregnancy, when should women begin taking folic acid?

As folate is important for organogenesis (the formation and differentiation of cells into the various organs like the eyes, brain, heart, etc.), it is most important for the developing baby to have access to sufficient folic acid in the first few months of pregnancy. In fact, a baby would benefit if a woman began taking prenatal vitamins before she even becomes pregnant. Generally, beginning prenatal vitamins one to two months before attempting to conceive is preferred, but even if this time is missed, expectant mothers should begin prenatal vitamins as soon as the pregnancy is recognized.  Folate is very important in the beginning of the pregnancy, iron is more important in the second half of pregnancy, and certain vitamins and minerals are important throughout. Generally, prenatal vitamins are recommended throughout pregnancy and are safe to take even when not pregnant.

3. Is there any difference in the amount or quality of folic acid in over-the-counter prenatal vitamins versus prescribed prenatal vitamins?

Folic acid found in over-the-counter (OTC) prenatal vitamins and prescription prenatal vitamins is usually about the same and both will have sufficient amounts to meet the minimum recommended intake, or 400 micrograms of folate. Some prescriptions will have extra, up to 1,000 micrograms, but there is no information to suggest that 1,000 micrograms is better than 400 micrograms for the average mom-to-be.  (Moms who have given birth to a baby with an open neural tube defect like spina bifida or anencephaly are usually recommended to take 1,000 micrograms each day, but there is no evidence to suggest this is a better approach for all women.)  

Generally, OTC prenatal vitamins suit most women perfectly well. Some are larger, some have a "fishy" smell, and some are chewable or even "gummy." What is important is to get the nutrients in, no matter whether through OTC pills, prescription or through a varied and healthy diet. Women should be encouraged to discuss any problems they are having with taking their vitamins with their doctor. There may be a better brand or type of pill that will work better for them. Some women stop taking the prescription because they are more expensive, and they are often ashamed to discuss this with their doctor. I would say this is a mistake, as there are usually cheaper options available that are just as effective.

4. If folic acid was not taken prior to pregnancy, what other sources of folic acid do we consume through our diet?

Folate  is an important part of any diet, at any age. It is naturally found in many different foods, such as dark leafy green vegetables like spinach, oranges, beans and lentils.  Commercially made breads (store-bought) are also fortified with extra folic acid.



5. Would there be a reason to take folic acid after childbearing years?

Because folate is most important in the month before pregnancy and the first two to three months after conception, a time when many women will not even recognize they are pregnant, a woman of childbearing years who has potential to become pregnant should consider taking a prenatal vitamin every day. This would help ensure she is taking the prenatal vitamin at the most optimum time if she were to become pregnant.
Prenatal vitamins are also important during breast-feeding and should be continued throughout this time as well. For women who have had anemia in the past, the extra iron in the prenatal vitamins may also be beneficial. In the end, prenatal vitamins can be one piece of a healthy lifestyle for women at any age, not just during pregnancy and breast-feeding.

6. What other considerations should be weighed when choosing a prenatal vitamin?

DHA and omega-3 fatty acids are important parts of brain and eye development. We think supplementation during pregnancy and while breast-feeding may promote brain and eye development, but the benefits of supplementation versus a healthy diet have not been proven. When selecting a prenatal vitamin, a woman should consider DHA supplementation, now often combined with the prenatal vitamin. Some women find this difficult, as they often have a fishy smell and/or aftertaste.  This can be particularly difficult toward the end of the first trimester when morning sickness is typically at its worst. If this is a problem, choosing a prenatal without the DHA and omega-3s may be more appropriate. The bottom line is that the specific brands and the "added bonus" of the DHA/omega-3 are much less important than having a pill that is tolerable for the patient so she can keep it down each day. It is almost important that the supplement is affordable enough that she can continue taking it.  

Dr. Patrick Dawson is an obstetrician-gynecologist at Southwest Medical Associates, part of the Lovelace Health System family. Dr. Dawson provides both ob-gyn services as well as high-risk OB. He is board certified and a fellow of the American Board of Obstetrics and Gynecology. To reach his office, call 505.823.1010.

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