The importance of folic acid intake before you get pregnant

Many people learn about the need for the need for folic acid to prevent birth defects after they have become pregnant

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Research linking the B-vitamin folic acid to the prevention of birth defects has been published in the medical literature since the 1960s. This vitamin is required in miniscule amounts during the first several months of pregnancy to ensure that the developing fetus' neural tube closes and protects the spine. When pregnant women are deficient in folic acid, the neural tube fails to close, and the infant faces a high risk of crippling and often deadly neural-tube defects, such as spina bifida.

The good news is that the relationship between folic acid and the prevention of birth defects is now well established. Even the March of Dimes has undertaken folic acid as its latest cause.

The bad news is that very little is being done to ensure that women actually receive sufficient folic acid. One problem is that many women do not realize they are pregnant at the time their fetuses requires folic acid the most.

Federal officials have for at least two years debated whether common foods, such as bread, should be fortified with folic acid. Such fortification would provide a reliable source of the vitamin for most women. There are a number of arguments against such food fortification, some sound, some not so sound.

Adding folic acid to bread might increase the cost of a loaf by 1¢. That doesn't seem like much, but some people have questioned whether the effort and cost are really worth saving only a couple of thousand babies each year. Another problem is that folic acid is extremely sensitive to heat, and the baking of bread might destroy much of the vitamin.

On the other hand, the problem of spina bifida may be far greater than most people imagine. As with any condition, there is a range in severity. Sometimes, the spine is exposed at birth, and the prognosis for the infant is very poor. At other times, neural tube defects may be more subtle. There are an unknown number of cases of "spina bifida occulta," in which the birth defect is mild and remains undiagnosed for years or even a lifetime.

The issue of folic acid supplementation takes on greater significance with the recognition that 10 to 40 percent of all cases of coronary heart disease and stroke appear related to inadequate intake of folic acid and other B vitamins. Instead of affecting 4,000 fetuses, folic acid deficiency could impact several hundred thousand Americans a year.

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http://kidshealth.org/parent/pregnan...olic_acid.html

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Folic acid, sometimes called folate, is a B vitamin (B9) found mostly in leafy green vegetables like kale and spinach, orange juice, and enriched grains. Repeated studies have shown that women who get 400 micrograms (0.4 milligrams) daily prior to conception and during early pregnancy reduce the risk that their baby will be born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70%.


The most common neural tube defects are spina bifida (an incomplete closure of the spinal cord and spinal column), anencephaly (severe underdevelopment of the brain), and encephalocele (when brain tissue protrudes out to the skin from an abnormal opening in the skull). All of these defects occur during the first 28 days of pregnancy - usually before a woman even knows she's pregnant.


That's why it's so important for all women of childbearing age to get enough folic acid - not just those who are planning to become pregnant. Only 50% of pregnancies are planned, so any woman who could become pregnant should make sure she's getting enough folic acid.

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http://vvv.com/healthnews/folate.html :

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It is unfortunately, estimated that 88 per cent of all North Americans suffer from a folic acid deficiency. Obviously, the standard diet does not supply what we need. This has led to the fortification of cereals and other foodstuffs to try to ensure a minimum daily intake of 0.4 mg/day. Although beans and green vegetables like spinach and kale are good sources of folic acid, relatively few people eat lots of vegetables and cooking destroys most of the folate anyway. Realizing the poor availability from the diet many medical researchers now advocate daily supplementation with folic acid. Because folic acid needs the catalysts vitamins B12 and B6 to carry out its functions effectively it is usual to supplement with a combination of the three.

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There is some discussion about folic acid supplements here: http://www.vegsource.com/campbell/messages/7409.html

Low folic acid levels are also associated with premature births:

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"Victoria Fletcher, health correspondent in The Daily Express, reports on a study at the University of North Carolina which has shown that women not taking enough folic acid during pregnancy double their risk of a premature birth. Up until now it had been thought that the use of folic acid only protected against spina bifida. The study involved 3,000 women and took over five years to complete. The subjects were asked to record what they ate and what supplements they took. Blood samples were also taken to assess the subjects' folate levels. The researchers found that the average amount of folate in the diet of women who carried their baby to full term was higher than those who gave birth more than three weeks early. The study suggests that women should continue to take just over 0.5mg of folic acid a day. There has been widespread concern after a preliminary study linked taking folic acid with an increased risk of breast cancer. "

Source: Daily Express (24/01/2005 )

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The numbers in the following list give the energy (in kcal) and folate (in µg) in one pound (453.6 g) of the following foods:

Broccoli, cooked, boiled, drained, without salt -- 159 kcal, 490 µg
Mustard greens, cooked, boiled, drained, without salt -- 68 kcal, 331 µg
Kale, cooked, boiled, drained, without salt -- 127 kcal, 59 µg
Cabbage, chinese (pak-choi), cooked, boiled, drained, without salt -- 54 kcal, 186 µg

Lettuce, butterhead (includes boston and bibb types), raw -- 59 kcal, 331 µg
Lettuce, cos or romaine, raw -- 77 kcal, 617 µg
Lettuce, green leaf, raw -- 68 kcal, 172 µg
Lettuce, red leaf, raw -- 73 kcal, 163 µg

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Folic acid (also known as vitamin B9 or folate) is one of the few nutrients known to prevent neural tube birth defects such as spina bifida, which affects about one in 1,000 pregnancies each year in the United States. The Centers for Disease Control report that women who take the recommended daily dose of folic acid starting one month before they conceive and throughout the first trimester reduce their baby's risk of birth defects such as spina bifida by up to 70 percent.

This alone is reason enough to make sure you take folic acid before you get pregnant and during pregnancy, but there may even be other benefits as well. Some studies have shown that women who don't get enough folic acid may increase their risk of miscarriage, as well as cleft lip and palate, limb defects, and certain types of heart defects in their babies

Your body needs this nutrient for the production, repair, and functioning of DNA, our genetic map and a basic building block of cells, so getting enough is particularly important for the rapid cell growth that occurs during pregnancy. Folate is also required for a complex metabolic process that involves the conversion of one amino acid in your blood (homocysteine) into another amino acid (methionine). If you don't get enough folate, you can end up with too much homocysteine in your blood, which is thought to contribute to some birth defects. Elevated levels of homocysteine in pregnancy also have been linked to blood clots, placental abruption, recurrent miscarriages, and stillbirth. Researchers are trying to find out whether taking folic acid throughout pregnancy decreases your risk for these problems. Finally, folate helps make normal red blood cells, prevent anemia, and produce the nervous system chemicals norepinephrine and serotonin.
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Should I take a supplement?
Definitely. If you're like most people, you don't get the amount of folate you need from your diet, and research shows that the body actually absorbs the synthetic version of this vitamin (found in supplements and enriched foods) much better than the version that occurs naturally in certain foods. On the days you can't stomach your prenatal vitamin in early pregnancy, at least take a separate folic acid supplement. (These pills are small and easy to get down.) But eating plenty of folate-rich foods won't hurt either, since the recommended daily amount you're supposed to get from your supplement is designed to complement the amount you're likely to get from food sources.

What are the best food sources?
Food manufacturers are required by the Food and Drug Administration to add folic acid to enriched grain products such as breakfast cereals, bread, pasta, and rice so that each serving contains at least 20 percent of the daily requirement, and some breakfast cereals contain 100 percent (400 mcg) or more. Dark leafy greens are also a good source of folate, as are legumes such as lentils and chickpeas. Other sources include the following:

•*1/2 cup cooked lentils: 179 mcg

•*1 cup boiled collard greens: 177 mcg

•*1/2 cup canned chickpeas: 141 mcg

•*1 medium papaya: 115 mcg

•*1 cup cooked frozen peas: 94 mcg

•*4 spears steamed or boiled asparagus: 88 mcg

•*1/2 cup steamed broccoli: 52 mcg

•*1 cup strawberries: 40 mcg

•*1 medium orange: 39 mcg

What are signs of a deficiency?
The signs of folic acid deficiency can be subtle. You may have diarrhea, loss of appetite, and weight loss, as well as weakness, a sore tongue, headaches, heart palpitations, and irritability. If you're only mildly deficient, you may not notice any symptoms at all, but you won't be getting the optimal amount you need for your baby's early embryonic development. That's why all women of childbearing age need to take folic acid, even if they feel perfectly well.

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Their views are based on people on a standard diet, which means that people eat less plants than vegans because they eat meat and dairy products instead. (If someone tells you that the vegan diet is not natural since vegans are more likely to become B12 deficient than non-vegans, maybe you should mention that a non-vegan diet is not natural since non-vegans are more likely to become folic acid-deficient than vegans? ;)

Women are recommended to take a folate supplement before they get pregnant. Vegan diets are often high in folate.

Folate 'may keep sperm healthy'

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A diet rich in the vitamin folate may protect men against producing abnormal sperm and children with genetic abnormalities, a study suggests.
Researchers found high dietary folate was linked to lower levels of sperm with the wrong number of chromosomes.

Folate, also protective against birth defects, is found in leafy green vegetables, fruit and pulses.

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This study is the first to suggest that paternal diet may play a role after conception in the development of healthy offspring
Professor Brenda Eskenazi
University of California, Berkeley

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More here.

Here's a study which shows thatg as many as two thirds of of women in the U.K. not taking folic acid before pregnancy to prevent spina bifida:

http://www.sciencedaily.com/releases...0219174853.htm

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Date: February 19, 2014
Source: Queen Mary, University of London
Summary: Less than one in three women have taken folic acid supplements before pregnancy to prevent spina bifida and other birth defects of the brain, spine, or spinal cord (neural tube defects). This is despite research from 1991 showing that such conditions could be prevented in most cases by increasing the intake of the B-vitamin folic acid before pregnancy. Each year in Britain there are about 1,000 pregnancies affected by spina bifida or other birth defects of the brain, spine, or spinal cord. Most of these lead to a termination of pregnancy which is an agonizing decision for couples who want a child.

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