Why do you have to take Folic Acid in Pregnancy?

Pregnant women are always advised to take folic acid supplements from as early in the pregnancy as possible. This is fundamental to ensure healthy development of the foetus. So what exactly is folic acid, what is it doing, why do you need it, where can it be found, and what are the risks if you don’t take it?

Folic Acid, also known as folate, is a water soluble vitamin B; vitamin B9 to be precise. It plays a crucial role in cell division and the production of both DNA and RNA which regulate and store genetic information. Due to the rapid cell division in early pregnancy as an embryo develops it is of particular importance.

What foods contain folic acid?

The human body cannot produce it’s own folate, it needs to be acquired in your diet. Folate naturally occurs in leafy vegetables such as spinach, pulses, broccoli, nuts, yeast extract, soybeans and liver. Folic acid is the synthetic version of folate which is made as a supplement.

How does folic acid prevent problems in early pregnancy?

The primary functions of folic acid within the early weeks of a pregnancy include:

1. Neural Tube Formation: Folic acid is fundamental in ensuring the proper formation of the neural tube, which eventually develops into the foetus’s brain and spinal cord. Deficiencies in folic acid during the first few weeks of pregnancy can lead to neural tube defects such as spina bifida and anencephaly.
2. DNA Synthesis: Folic acid is essential for making and repairing DNA. This process is crucial during early pregnancy as cells rapidly divide and differentiate to form various organs and tissues.
3. Red Blood Cell Formation: Folic acid also has a function in red blood cell formation, preventing anaemia, which is common during pregnancy.
4. Amino Acid Metabolism: Folate contributes to the metabolism of amino acids, which are the building blocks of proteins required for fetal growth and development.

How did they discover that folic acid was important in pregnancy?

The importance of folic acid was not always well understood. It was through extensive scientific research that its crucial role in early pregnancy became evident. One landmark study that contributed to this understanding was conducted by Dr.Lucy Wills in the late 1920s.This pioneering work was instrumental in discovering the connection between folate and healthy babies, leading to improved maternal and child health outcomes worldwide.

Dr Wills’ research focused on a mysterious condition known as “tropical anaemia,” prevalent in South Asia. She observed that pregnant women suffering from this condition often had adverse pregnancy outcomes, including stillbirths and neural tube defects in their babies. Dr Wills conducted experiments using nutritional interventions and discovered that a yeast extract, rich in folate, could effectively treat and prevent this condition. This groundbreaking research laid the foundation for understanding the role of folic acid in pregnancy.

Further scientific investigations backed up these findings and widened our knowledge of folic acid’s importance during early pregnancy. Research studies using animal models and cell cultures provided valuable insights into the molecular mechanisms by which folate deficiency can lead to neural tube defects and other developmental abnormalities.

The CDC (Centers for Disease Control and Prevention) in the USA has collaborated with The University of Peking in extensive research spanning many years. One notable programme involved women being given 400 mcg of folic acid; these women showed a significant in the numbers of babies being born with neural tube defects in prevalent areas.

A notable study published in 1991 by the Medical Research Council Vitamin Study group quoted a protective effect of over 70% lower risk of neural defects in babies born to mothers who had been taking folic acid. https://www.thelancet.com/journals/lancet/article/PII0140-6736(91)90133-A/fulltext

What are the risks of not taking folic acid in pregnancy?

Folic acid deficiency during pregnancy can have serious consequences for both the mother and the developing embryo. Some of the notable effects include:

1. Neural Tube Defects: The most well-known consequence of folic acid deficiency in pregnancy is an increased risk of problems in the neural tube. The neural tube contains the beginnings of the brain, spinal cord and central nervous system. Severe birth defects may affect the development of these crucial structures, or their protective coverings. Babies born with neural tube defects may have serious disabilities or may not survive.
2. Anaemia: Folic acid deficiency can lead to megaloblastic anaemia, a condition in which the body produces abnormally large red blood cells which do not function efficiently. This can result in fatigue, weakness, and shortness of breath, which can be particularly problematic during pregnancy when the body’s demand for oxygen increases.
3. Premature Birth and Low Birth Weight: Folic acid deficiency may also increase the risk of premature birth and having a baby with low birth weight, both of which are associated with health complications for the newborn.
4. Developmental Delays: In addition to neural tube defects, folate deficiency during early pregnancy can lead to developmental delays and cognitive impairments in the baby.

Numerous other studies have investigated the significance of folic acid with relation to other issues including heart defects, pre-eclampsia and even autism.

Should you take folic acid before getting pregnant?

Evidence is also clear that taking folic acid prior to conception is beneficial. A huge part of the protective benefit this supplement offers occurs within the very first weeks of pregnancy. The challenge here is that many women do not begin to take folic acid, or consider relevant dietary issues until they realise they are pregnant, by which time a significant amount of cell division and crucial cell differentiation and development has already occurred. This is particularly an issue with unplanned pregnancies. The UK government quotes a statistic of 45% of all pregnancies in England being unplanned, so it is likely that many of these women are not taking the recommended dose of 400 micrograms per day.The NHS recommends taking folic acid for the first 12 weeks of pregnancy, and ideally for 3 months before conception.

Can you get folic acid free when you are pregnant?

Folic acid supplements are reasonably priced in supermarkets in the UK. Specific pregnancy multivitamin supplements containing folic acid plus other vitamins and minerals are usually more expensive. In the UK, the NHS Healthy Start programme offers free vitamins to pregnant or breastfeeding women, however as mentioned above, it is advisable to start folic acid even before you would qualify for this programme. https://www.healthystart.nhs.uk/getting-vitamins/

Both pregnant women and those planning to conceive should prioritize adequate folic acid intake through a combination of a balanced diet and supplementation, as recommended by medical professionals worldwide. By doing so, they can significantly reduce the risk of birth defects and other adverse outcomes, ensuring a healthier start for both mother and baby on their incredible journey.