What is folic acid?

3d vitamin B9 pill on spoon over white background

Folic acid is one of the B group of vitamins – it is known as vitamin B9 and is also referred to as folate. Folic acid has an important role in ensuring healthy cell growth and development; however, it becomes even more important prior to conception and during the early weeks of pregnancy. Conclusive research evidence has existed for over 20 years, which shows that an adequate daily consumption of folic acid before and during the early weeks of pregnancy, promotes the healthy development of the fetal brain and spinal cord. Research shows that adequate folic acid intake considerably reduces the risk for neural tube defects (NTDs).

What are neural tube defects (NTDs)?

NTDs affect over 900 pregnancies in the UK each year, which equates to 1 in 1000 pregnancies. NTDs include, spina bifida, anencephaly and encephalocele. These are serious birth defects of the brain and spine that occur during the first month of pregnancy, when the neural tube fails to close completely.
Spina bifida is a condition where there is incomplete closing of the vertebrae (backbone) and the membranes surrounding the spinal cord. The condition often leads to lifelong disability and most people affected are wheelchair users.
Anencephaly is a condition where the baby’s brain and skull fail to form properly – it is almost invariably incompatible with life outside the womb and fatal.
Encephalocele is a condition characterised by a sac-like protrusion of the baby’s brain and the membranes that cover it through openings in the skull. The severity of the condition depends on its location.

NB. Most NTDs can be prevented if women receive enough folate before and during pregnancy. A study undertaken by the Medical Research Council in 1991 found that folic acid could help prevent the number of pregnancies affected by a NTD by up to 72%.

What are the folic acid recommendations for pregnancy?

The Department of Health recommends that women should take a daily supplement of 400 micrograms (400mcg) of folic acid while they are trying to conceive (ideally for at least three months

Leafy vegetables - spinach, Brussels sprouts, leeks, parsley, broccoli, lettuce - lying on a wooden table

prior to conception), and should continue taking this dose for the first 12 weeks of pregnancy. This is the period when the baby’s brain and spine are developing. However, it is safe to continue taking folic acid supplements beyond 12 weeks of pregnancy.

But I’m already pregnant…?

Around half of all pregnancies in the UK are unplanned, so it is recommended that women ensure they are as healthy as they can be, just in case they do become pregnant. Consequently, it is recommended that all women of a childbearing age, take 400mcg of folic acid daily whether this is as part of a multivitamin, or as a single supplement.

If you didn’t take folic acid supplements before getting pregnant and are less than 12 weeks pregnant, the Department of Health recommends that you start taking folic acid as soon as you know you’ve conceived.

Folic acid and high-risk pregnancies

Some women are considered to be at greater risk of having a pregnancy affected by a NTD. This can be because the woman or their partner have NTDs themselves; they have had a previous pregnancy affected by a NTD; there is a family history of NTDs; the woman has diabetes or coeliac disease, or is taking anti-epilepsy medication.

Where this is the case, the Department of Health recommends that women take a higher daily dose of folic acid – 5 milligrams (5mg) whilst trying for a baby and until they are 12 weeks pregnant. This dose of folic acid is only available on prescription from your GP, so it is advised that you see your GP early for their advice before trying to get pregnant.

If you are at a higher risk of having a pregnancy affected by a NTD, your GP and midwife may recommend additional antenatal screening tests in pregnancy to keep a closer eye on your baby’s development.

How do I ensure I’m getting enough folic acid?

Folic acid supplements – You can get folic acid supplements in tablet form from your local pharmacy/chemist, most of the large supermarkets, health food stores, or on prescription from your GP. One folic acid tablet, taken daily, contains precisely the right amount of folic acid that the Department of Health recommends for the healthy development of your baby’s brain and spine.

Folate-rich foods – There are a number of foods that are rich in folic acid; these include green, leafy

Lettuce, broccoli and greensvegetables such as spinach, curly kale, broccoli, brussels sprouts, savoy cabbage and asparagus – the darker green the leaves, the better!
Folic acid is also found in brown rice, breakfast cereals which are fortified with folic acid, as well as whole-wheat products such as granary bread. It is also found in dried beans, lentils, peas and oranges.You can check the folic acid content of different foods by checking the product’s food labels.

Food safety

Liver is also very rich in folic acid, however it is not safe to eat while you are pregnant or trying to become pregnant. This is because liver contains abnormally high levels of vitamin A (called ‘retinol’) which has been linked to babies being born with birth defects. For further information see, ‘Healthy eating for you and your baby’.

Is eating folate-rich foods sufficient?

Whilst eating foods that are rich in folic acid is very beneficial to you and your developing baby, studies have found that it is virtually impossible to receive sufficient amounts of folic acid through

diet alone. Consequently, the best way of ensuring that you get the recommended 400mcg intake of folic acid is to take a daily supplement.

Are there any additional benefits to taking folic acid?

More recent research has demonstrated that folate supplementation has an important role in maintaining health for your baby during pregnancy, right through into childhood and beyond, with emerging research indicating folate can prevent chronic disease in later life. Of particular interest is the link between folate and brain health during ageing and the longer term effect of folate exposure in pregnancy on children’s cognitive development.

Go Folic!

Go Folic! Launched in 2010 and is a national campaign that aims to inspire all women of a child-bearing age to take 400mcg of folic acid each day before they become pregnant. For more information visit: www.gofolic.org.uk.

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