Introduction:
Folate is an essential nutrient required for DNA (deoxyribonucleic acid is a hereditary material present in all living organisms) replication and folate is also involved in a range of enzymatic reactions of amino acid synthesis and metabolism of vitamins. Thus demands for folate quickly increase during pregnancy as it is essential for the development and growth of the fetus. Gynecologists advise women during their prenatal period to consume at least 400 micrograms of folic acid daily for three months before conception. However, receiving this amount of folic acid by diet alone is quite difficult hence women planning to conceive and pregnant women are advised to take 400 mcg of the folic acid tablet while eating folic acid-fortified foods, and natural sources of folic acid food also.
What Is Folic Acid and What Are Its Sources?
Folic acid is a vitamin B. As stated above, human bodies require it to make new cells that form different parts such as skin, hair, nails, and other internal parts of the body as they make new cells every day. Folic acid is the man-made synthetic form of folate that is added to supplements and fortified foods. Although folate and folic acid are often used interchangeably, they are different. Folate is a generic term for many different types of vitamin B9.
Vitamins and minerals are added to the food, which is called food fortification. Folic acid is the most stable form of folate for food fortification. Heat and light can easily break down other types of natural food folate hence folic acid is better suited as it remains stable in those conditions and many fortified products including pasta and rice need cooking at high temperatures. Folic acid is added by fortification in some pasta, bread, rice, and breakfast cereals. Usually, these foods are labeled enriched with folic acid.
What Are the Benefits of Taking Folic Acid Before Pregnancy?
1. Folic Acid Prevents Neural Tube Defects in Fetus:
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Neural tube defects are common but complex congenital malformations of the nervous system due to failure of closure of the neural tube during the development of the child in the womb. The prevalence of neural tube defects varies widely between one to ten per one thousand births. Neural tube defects include craniorachischisis, encephalocele, spina bifida, and myelomeningocele.
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The cranial defects such as craniorachischisis are lethal at or before birth, while spina bifida has a comparably more postnatal survival rate. However, Spina bifida cystica is a more severe form with a high risk for morbidity and mortality during the course of their life. Only one percent of children born with this open form of neural tube defects are free from disability. Affected children usually suffer from anesthesia of the skin, abnormalities of knees, hips, and feet, inability to walk, minimal or no bowel and bladder control, and also may need frequent surgical procedures to decrease the effects of hydrocephalus.
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In addition to folate deficiency, other factors can also cause neural tube defects such as genetic factors, environmental factors such as the occupation of women, obesity, and nutritional status of women at the time of conception.
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Current recommendations include taking 600 micrograms of folic acid for women at high risk of giving birth to a child with neural tube defects such as to women with a personal or familial history of such defects, a prior child with this defect, or to women taking anticonvulsant medications.
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Despite the recommendation of a prenatal course of folic acids, an estimated 50 % of females do not plan their conception and hence may not take folic acid supplementation prior to conception. But the closure of the neural tube in the embryo (early developing fetus) is finished 28 days after conception. Hence, there is a very narrow window of opportunity for a woman from the time of confirmation or hint of conception and the end of this prevention window. This fact mandates for women to take folic acid preconception to prevent neural tube defects.
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Recent studies have established that a daily intake of folic acid provides the women five-fold increase in folate and a two-fold increase in red blood cells. For women, the window of opportunity for preventing neural tube defect is brief hence a high dose of folic acid is more effective for bringing the folate concentrations into the desired range.
2. Folic Acid and Prevention of Anemia
- As part of normal physiologic changes occurring during pregnancy, blood volume expansion happens due to increased plasma and red blood cells. However, more plasma (the liquid portion in the blood) is usually added to the mother’s blood circulation than red blood cells. But the increase in red blood cell volume is also considerable. Because of this increase in plasma volume, the hemoglobin concentration normally decreases slightly during pregnancy.
- According to the studies, approximately five percent of women are anemic during pregnancy with hemoglobin levels below 11.0 g/dL. Red blood cell formation happens in the hematopoietic tissue in the bone marrow. During this process of red blood cell formation, sufficient supplies of three key nutrients are essential that are folate, iron, and cobalamin (vitamin B12). Hence, in women with low folate or vitamin B12 before conception, the risk of anemia during pregnancy increases. Taking folic acid prior to conception raises body storage of folate which helps to lower the risk of anemia.
Conclusion:
There is clear study data that establishes folic acid’s protective effect on the occurrence and recurrence of neural tube defects. However, the mechanisms by which folic acid promotes neural tube complete closure remain unclear. But, the closure of the neural tube happens after 28 days of conception which is the time most women are unaware of their upcoming pregnancy, hence they miss the chance to prevent neural tube defects. This demands sufficient concentration of folate in the mother's body prior to conception to lower the risk of neural tube defects and anemia, the doctor advises women to take folic acid in addition to consuming dietary folic acid-fortified foods. The doctor may prescribe higher than regular folic acid doses to a woman with a higher risk of probability of having a child with a neural tube defect.
