Risk of folic acid deficiency during pregnancy

Folic acid is essential during pregnancy, doctors say, but not just during pregnancy – future mommies should take it even before conception. It can prevent neural tube damage, helps in the development of the central nervous system, cell division and blood production, and contributes to the synthesis of amino acids. It is best if women who plan to become pregnant start taking it immediately after stopping the birth control pill, or as soon as they start planning their pregnancy.

Folic acid is a vitamin B, precisely a water-soluble form of vitamin B9. The human body is not capable of producing it, so we have to consume it with food. Its name comes from the Latin word folium, which means leaf. Coincidence? Not really, because leafy vegetables are an excellent source of folic acid in the diet. Folic acid is found in green vegetables (broccoli, green peppers, lettuce, spinach, Brussels sprouts), peas, lentils, chickpeas, black beans and other legumes, nuts, and certain fruits such as bananas and citrus fruits. However, since the folate found in this type of food is sensitive to high temperatures, light, and oxidation and is also water soluble, avoid prolonged cooking of folate-rich foods.

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Folic acid plays a crucial role in the development of the central nervous system in the fetus

Folates play a key role in the synthesis of DNA and amino acids, are involved in cell division, blood production, and immune system function. Folic acid takes care of the formation, metabolism, and proper functioning of the blood cells. It prevents abnormalities in the closing of the neural tube. Therefore, folic acid is particularly important at the beginning of pregnancy, when the neural tube closes, and the embryo’s spine and nervous system begin to form.

Neural tube

The neural tube is a fetal structure from which brains and spinal cord develop. As such, it forms the basis of vital organs and abnormalities in its development cause a group of defects, also called neural tube defects. The process of developing and closing of the neural tube and vertebral arc takes place within the first four weeks after egg fertilisation.

Gynaecologists recommend taking folic acid before a planned pregnancy. Indeed, folic acid consumption during pregnancy has been shown to reduce the chances of abnormal fetal development and neural tube damage by up to 70%.

When a woman finds out she’s pregnant, she is nearing the 5th week of pregnancy. Gynaecologists consider the first day of the last period to be the start of the pregnancy. When a woman performs a test (if she does it immediately), she is already 4 weeks along. Folic acid is crucial during these early weeks; between weeks 8 and 12, it contributes to the development of the fetus and its nervous system. That’s why taking folic acid as a preparation for pregnancy is crucial.

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Folic acid levels in women taking the contraceptive pill are alarmingly low

Some studies have shown disorders of vitamin B9 metabolism (folic acid) in women taking oral contraception. After a prolonged period of taking birth control pills, folic acid levels may decrease in the body. However, they are crucial for healthy embryonic development. So when a couple decides to have a child, experts recommend that the woman stops taking birth control pills and the couple uses other methods of protection for three months. During these three months, women should start taking folic acid.

Folic acid is also useful later in pregnancy and during lactation, as it strengthens the immune system and prevents anaemia. Before planned pregnancy, during pregnancy and lactation, gynaecologists recommend 400 micrograms of folic acid daily in the form of dietary supplements.

Higher risk requires higher doses

Couples who have a higher risk of neural tube defects should be much more alert to folic acid needs before and during the planned pregnancy. Usually, in these cases, your doctor also advises a higher dose.

Your risk is higher in the following cases:

  • Diabetes
  • Epilepsy
  • Presence of neural tube defects in the couple planning pregnancy
  • Fetus with neural tube defects in past pregnancies
  • Family history of neural tube defects
  • Consumption of large amounts of alcohol
  • Frequency of neural tube defects and consequences for the child

    If the neural tube does not close properly and completely, the neural tube defects occur.

    Neural tube defects are one of the most common defects in babies at birth and affect 300,000 newborns worldwide annually. Among the most common is spina bifida. Depending on the type of neutral tube damage, spina bifida is divided into:

  • Spina bifida occulta: one of the most common congenital abnormalities present in a quarter of children in adolescent age. There is a small gap in the spine, but no opening or sac on the back, and it usually doesn’t cause any disabilities. The skin above the deformation can contain a hairy patch, a dimple or a birthmark.
  • Meningocele: this type is characterised by a sac of fluid protruding from an opening in the baby’s back. The spinal cord is not in this sac, and there is usually little or no nerve damage.
  • Myelomeningocele: the heaviest form of spina bifida. A sack protruding from the baby’s back contains not only fluids but also part of the spinal cord and nerves. Both are damaged and cause moderate to severe disabilities.
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