The CDC and the U.S. Public Health Service recommend that all women between the ages of 15 and 49 take 400 micrograms (mcg) of folic acid a day. Taking folic acid before pregnancy provides a number of health benefits for both mom and baby. More specifically, taking folic acid before pregnancy can help prevent birth defects of the baby’s brain and spine.
In this article, we discuss what folic acid is and share some of the major benefits of folic acid before pregnancy.
About Folic Acid
Folic acid or folate (more on the difference between the two in a bit) is a water-soluble B-vitamin. Folic acid is vitamin B9, to be exact. Our bodies need it to make DNA, and it is essential for cell division. Needless to say, it is a pretty important vitamin.
Folic Acid vs. Folate
You often hear the terms “folic acid” and “folate” used interchangeably, which can sometimes cause confusion. “Folate” is a generic term referring to both natural folate and folic acid, as well as other types of folate found in dietary supplements (such as methylated folate).
Certain foods like lentils, chickpeas, asparagus, and spinach contain natural folate. Whole food is the only source of natural folate. Likewise, there are no folic acid food sources.
In general, getting nutrients from foods is preferred to getting them from supplements. However, there may be some differences of opinion when it comes to folate.
Carolyn Gundell, M.S., Fertility Nutritionist from Reproductive Medicine Associates of Connecticut, reminds us that folate from foods cannot replace folic acid from supplements. The body can only partially absorb naturally occurring folate (50-60% of it). Also, cooking folate-rich foods destroys as much as 50-90% of the folate found within them.
It is a good idea to make sure you balance your diet with healthy, natural sources of folate as well as a moderate amount of folic acid (or methylated folate) from supplements.
Folic acid fortification is when food manufacturers add folic acid to foods that do not naturally contain folate. Beginning in 1998, the USDA required food manufacturers to add folic acid to certain food products. Enriched bread, flour, cornmeal, rice, pasta, and other grain products contain 400 mcg of folic acid.
The Harvard T.H. Chan School of Public Health recommends, however, that you stay away from heavily fortified foods. They suggest relying on a daily multivitamin containing folic acid instead.
When a person consumes folic acid, the body converts it to the metabolically active form called methylated folate (or L-methylfolate). While this form contains the word “folate,” it is not the same as naturally occurring folate.
Some women have a genetic defect (called MTHFR polymorphism) which makes it hard for them to activate folic acid to a form that their bodies can use. This genetic defect does not prevent those with the defect from activating folic acid; it just reduces their ability to do efficiently.
About 20-50% of the population have one copy of the defective gene, reducing the capacity to activate folic acid by about 30%. A much smaller percentage of the population (3-30%) have two copies of the defective gene, which reduces the ability to activate folic acid by about 65%.
Some preconception prenatal vitamins contain the active form of folic acid (methylated folate). Using methylated folate helps ensure that women with the genetic defect are absorbing the right amount of folate to prepare for pregnancy. The formation of the neural tube occurs very early in pregnancy (21-27 days after conception), sohe most important time to take methylated folate is while trying to conceive and during early pregnancy.
Benefits of Folate Before Pregnancy
Now that we know about the different types of folate, we can answer the question – what are some of the benefits of taking folate before pregnancy?
Folate helps with many of the body’s normal processes. Perhaps the most well-known benefit is that folate decreases the risk of birth defects of the baby’s brain and spine. There is a strong connection between adequate folate and neural tube defects.
These birth defects are called neural tube defects (NTDs). What is the neural tube, you may ask? The neural tube starts out as a tube-like grouping of cells inside the embryo.
Eventually, that tube closes and becomes the baby’s spinal cord and brain. If the tube does not close completely during pregnancy, the baby is said to have an NTD.
The most common NTD is spina bifida. When a baby has spina bifida, the tiny bones that make up the vertebrae do not close completely and the spinal cord pokes through the spine.
Spina bifida affects roughly 1,500 babies in the United States each year. Health consequences of spina bifida can include paralysis in the legs and difficulty controlling the bladder or bowel. In some cases, doctors can treat spina bifida with surgery before or after birth.
One of the more severe NTDs is anencephaly. When the upper part of the neural tube that forms the brain does not close completely, a baby can develop anencephaly.
Approximately 1,000 babies are born with anencephaly in the United States each year. Children with this NTD are missing major parts of their brain, skull, and scalp. Survival rates are low, and babies born with anencephaly can typically only survive for a few hours after birth.
Encephalocele is another NTD affecting roughly 375 babies in the United States each year. This NTD occurs when the sac that contains the membranes that cover the brain (and often a part of the brain, as well) pokes through an opening in the skull.
Babies with encephalocele usually require surgery to place parts of the brain back into the skull and close the opening. If there is a buildup of fluid in the brain, the baby will need a drain put in to remove the excess fluid.
The outlook for babies born with encephalocele depends on the location of the opening, the parts of the brain affected, and whether or not they have other birth defects. More often than not, a child with encephalocele will face some challenges including intellectual disability, movement problems or paralysis, vision problems, or seizures.
Recommended Timing for Folate Before Pregnancy
The neural tube closes around the fourth week of pregnancy (about 28 days after conception), so it is important to start taking a supplement with folate at least one month before conception and continuing throughout pregnancy.
Because the neural tube closes before many women even know they are pregnant, it is important for women of childbearing age to take enough folate even if they are not planning a pregnancy. According to the CDC, roughly 50% of all pregnancies in the United States are unplanned.
The most important takeaway is that folate is beneficial for any woman who may become pregnant.
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