Is Folic Acid a Superhero in Pregnancy?

If you’re planning a pregnancy or already pregnant, it is recommended to consume a sufficient amount of folate, the synthetic form of B9 vitamin called folic acid. Taking 400 mcg of folic acid daily before and during pregnancy can significantly prevent neural tube defects, which are congenital brain and spinal cord abnormalities, in your baby.

The neural tube, where the brain and spinal cord develop, forms during the first 4 weeks of intrauterine life. Neural tube defects, a wide range of congenital conditions, can occur due to a combination of genetic and environmental factors, but the exact causes are not entirely proven. These defects can range from an opening in the spinal cord (spina bifida) to the brain being completely outside (anencephaly). Neural tube defects are among the most common congenital anomalies, with a prevalence of 0.3% in Turkey, 0.1% in Europe, and 0.2% in the USA. If a couple has had a child with a neural tube defect previously, the chance of observing it in their second child is about 3-5%.

Prominent health organizations report that taking 400 mcg of folic acid daily for at least a month before conception and during the first three months of pregnancy reduces the occurrence of neural tube defects by 70%. Some researchers also argue that folic acid taken during the first three months of pregnancy reduces the risk of cleft palate, cleft lip, and certain congenital heart diseases. It is claimed to reduce the risk of severe hypertension and preeclampsia during pregnancy by 5%.

So what does folic acid do for you? Adequate intake of folate, obtained through diet, plays a significant role in preventing anemia by increasing the production of red blood cells. Additionally, folate is important for the function, repair, and production of DNA, the building block of the genetic map and cells. Having enough folate is crucial for the rapid cell growth observed in the placenta and the baby’s development.

Food sources rich in folate (natural folic acid) include green leafy vegetables, oranges, lentils, broccoli, tomato juice, brown rice, whole grains, and foods fortified with folate. However, getting a sufficient daily amount of folate through food alone is not always possible due to variations in folate content affected by storage conditions and cooking. Studies have shown that synthetic folic acid taken externally is absorbed more than natural folate from food through the intestines. The richest source of folate is liver, but excessive consumption of liver during pregnancy or taking vitamin supplements with liver intake increases the risk of vitamin A toxicity, which can cause congenital defects during pregnancy.

As more than half of pregnancies are unplanned, the American College of Obstetricians and Gynecologists recommends daily use of 400 mcg of folic acid for all women of reproductive age. If a woman visits a doctor during the early stages of pregnancy, some health organizations recommend 600 mcg of folic acid. If not recommended by your doctor, you should not take more than 1000 mcg (1 mg) of folic acid.

When do you need more folate?

In obese individuals, the risk of giving birth to a baby with a neural tube defect is higher than in normal-weight women. Therefore, if you are overweight, you can consult your doctor to take a higher dose of folic acid.

Pregnant women with a history of a baby with a neural tube defect have a 3-5% chance of having another baby with a neural tube defect. The recommended folic acid dose for these pregnant women is 4000 mcg (4 mg).

If there is a twin pregnancy, you can take up to 1000 mcg (1 mg) of folic acid after consulting your doctor.

Women using antiepileptic or antidiabetic medications have a higher risk of giving birth to a baby with a neural tube defect. Pregnant women using such medications can consult their doctor to take a higher dose of folic acid. Similarly, pregnant women with a methylenetetrahydrofolate reductase (MTHFR) mutation should have the folic acid dosage determined by their doctor.

Is there a connection between excessive folic acid intake during pregnancy and autism?

In early 2016, a study from Johns Hopkins University in the United States gained attention in the American media, suggesting that excessive use of folic acid and B12 vitamins during pregnancy increases the risk of autism in children. The study found that children born to mothers with high levels of folic acid and B12 in their blood at birth, who also took multivitamins during pregnancy, had a higher risk of autism and similar conditions. The researchers, especially those of reproductive age, argue that the fortified folate supplements added to foods, like folate-fortified breakfast cereals, designed to prevent neural tube defects, increase the risk of folate toxicity. They suggest that only taking the required amount of folic acid and B12 vitamins is recommended based on this study.

In conclusion, taking folic acid in early pregnancy is important. However, we still need more time and studies to calculate the safe dose of folic acid throughout pregnancy.