07Aug, 2024
Folic Acid: A crucial part of healthy pregnancy
What is Folic acid?
Vitamins are quintessential for normal growth, metabolism and functioning of cells. They are needed only in small quantity for normal health. Of the many kinds of vitamins, Folate or Folic acid are forms of vitamin B9. Folate is a natural form of the vitamin, whereas folic acid is a synthetic form of it. They are crucial for many functions in the body such as DNA&RNA production, red blood cell formation, brain health, and more.
Why is Folic acid given during pregnancy?
Every year, there are approximately 3-4 lakhs infants born with congenital abnormalities such as spinal bifida and anencephaly. These are otherwise called neural tube defects. Several studies found a direct relationship between decrease in folic acid intake and increased risk of neural tube defects in the newborn babies. Periconceptional intake of folic acid has been reported to reduce the occurrence and reoccurrence of neural tube defects in the first or subsequent pregnancies respectively.
What are neural tube defects and their consequences?
In the initial days of embryonic development, neural tube closure occurs. Neural tube closure is important for the formation of skull and brain development. In neural tube defects, there is failure of the neural tube closure which causes congenital defects such as spina bifida, anencephaly and more. Spina bifida is one of the commonest neural tube defects where there is presence of part of spinal cord outside of the baby’s body. spina bifida could lead to bladder and bowel control problems or leg paralysis. Anencephaly is a serious and fatal manifestation where a part of skull or brain is not developed.
How Folic acid deficiency causes neural tube defects?
Folic acid/ folate is an essential vitamin involved in several cellular mechanism such as homocysteine remethylation, purine, dTmp biosynthesis and more. The definitive mechanism of folic acid deficiency causing neural tube defects is yet to be confirmed. However, one mechanism supporting its involvement is its role in nucleotide synthesis. In embryonic life, the neural tube cells are rapidly dividing and require large amounts of nucleotides for proper functioning of DNA replication. Folate deficiency could hinder cellular proliferation due to inadequate nucleotides thereby slowing the process of neural tube closure.
Who needs folic acid?
All women need folic acid for healthy pregnancy. It is especially important for women who have history of neural tube defects in their previous pregnancy. Folate/folic acid is not only related to birth defects, but it also plays a role in the prevention of heart and blood vessel disease, stroke, cancer, depression, dementia and folic acid deficiency.
What are the food sources of Folate/folic acid?
It is found in many foods, especially in dark green leafy vegetables, fruits, nuts and beans. Fortified cereals are excellent sources of folic acid. Below is the list of food items which contains folate
- fruits and vegetables
- bean and peas
- protein foods such as egg, liver etc
- fortified instant breakfast cereal
- Fortified breads and grains
What is the dose and recommendation of folic acid supplementation?
Synthetic form of vitamin B9 has better bioavailability, hence increasing intake of food rich in folate is less absorbed than folic acid supplements. Women who are planning a pregnancy should consume 0.4mg or 400micrograms of folic acid every day to reduce the risk of neural tube defects in the future child. For women who have previously had a pregnancy affected by a neural tube defect should consume 4000 micrograms of folic acid per day.
What are the side effects of folic acid?
Folic acid is usually safe, serious complications are rare. Some people with allergies might react with skin rash, itching, redness or difficulty breathing. Excess folic acid intake can mask vitamin B12 deficiency, this could delay their diagnosis.
Conclusion
Maternal folic acid is protective for babies and prevents neural tube defects primarily spina bifida and anencephaly. Although the mechanism of action of folic acid in preventing neural tube defects is not well established, the benefit of intake is definitive. Since prevention of neural tube defects is an extremely important public health issues, tremendous effort has been made by the government to encourage folic acid intake.
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