Do Expectant Mothers Need Folic Acid?
Tuesday, February 4, 2014
Folic acid, a type of B vitamin, contributes to the development of a healthy fetus, specifically affecting the formation of the brain and spinal cord. The vitamin can help prevent birth defects of the brain and spine.
When to start taking folic acid
Spina bifida is the most frequent spinal cord disorder in children, according to Sally Evans, MD, director of Children’s National Health System’s Division of Pediatric Rehabilitation Medicine, and medical director of the Spina Bifida Clinic.
Supplementation of folic acid before conception reduces the risk of spina bifida (open spine), a neural tube defect, Dr. Evans said.
“There is evidence irrefutable that shows that folic acid taken prior to pregnancy can drastically reduce the incidences of myelodysplasia or spina bifida,” Dr. Evans said.
Why is it important?
Vital fetal growth happens early in pregnancy. Failure of the fetal neural tube to close, or spina bifida, can develop within 30 days after fertilization, Dr. Evans said.
“Most people say it happens on day 28. That’s why it’s important for the folate to be taken before pregnancy because if you wait until you know you’re pregnant, it’s probably too late,” she said.
Risk factors for spina bifida are genetic (taking folic acid doesn’t affect/prevent that, Dr. Evans said) and environmental – for example, the mother’s weight and the use of anticonvulsant drugs, or drugs that treat epilepsy, and their effect on the environment in which the baby is growing.
How much is needed?
Dr. Evans said everyone needs folic acid since our bodies use the vitamin to make new cells. About 400 micrograms is the daily allowance recommended for women before they become pregnant to help prevent major birth defects of the baby's brain and spine.
“Only one-third of U.S. women of childbearing age consume the recommended amount from diet alone,” according to the National Council on Folic Acid.
Dr. Evans said women who could possibly become pregnant can get the recommended 400 micrograms by taking a daily multivitamin or by eating fortified foods such as grains, pastas, breakfast cereals, green vegetables, and fruits.
Higher risk among Latina/Hispanic mothers
“The Centers for Disease Control and Prevention (CDC) report that out of every 10,000 births, approximately 4 Hispanic children are born with spina bifida, compared to about 3 non-Hispanic blacks and about 3non-Hispanic whites,” wrote Hope Gillette for Voxxi, a news website with a Hispanic focus.
“Hispanic babies are more likely than others in the U.S. to be born with an NTD (neural tube defect). The Centers for Disease Control and Prevention report that Latinas in the U.S. consume the least amount of folic acid and have the least knowledge about folic acid among racial or ethnic groups,” according to the National Birth Defects Prevention Network.
Dr. Evans said with an increase in consumption of foods with the vitamin and supplements, experts have seen incidences of spina bifida decrease in expectant white and African American mothers. Also, a decrease has been noted among members of groups more susceptible to receiving medical information in English – more so in English-speaking versus non-English-speaking mothers.
Dr. Evans emphasized that Hispanic families are not more genetically predisposed to have children born with this neural tube defect, noting that the highest rates have been observed among those of Celtic, Scottish, and Irish descent.
About the Expert
Sarah EvansDivision Chief, Pediatric Rehabilitation Medicine
Sally Evans, MD, is director of the Division of Pediatric Rehabilitation Medicine and medical director of the Spina Bifida Clinic, both at Children's National Health System.