In detail

Folic acid during pregnancy

Folic acid during pregnancy

About folic acid supplementation, there is a universal consensus that all women of reproductive age (18-45 years) should supplement a balanced diet with 0.4-0.8 mg folic acid daily.

People cannot synthesize folate, so we depend on the external intake of food - the richest in folates being green leafy vegetables, citrus fruits, liver, grains and legumes with beans such as beans.

It has been known for about 30 years that folic acid supplementation during the preconception period (ideally 3 months before pregnancy) and in the first trimester of pregnancy (up to 12 weeks) reduces the risk of neural tube abnormalities in the fetus, such as anencephaly and spina bifida are among the most common congenital defects encountered.

These neural tube defects occur with a frequency of about 1/1000 pregnancies. There is a higher risk in patients who have a family or personal history of neural tube defects, but most cases occur in women without a history of such personal or family disorders.

In the US since 1998 the FDA (Food and Drug Administration) allowed the folic acid supplementation of cereal products and a 26% reduction in the incidence of neural tube defects was observed.

Other benefits of folic acid that recent studies show are higher cognitive development of these children who have a higher IQ, reduce the risk of autism and speech delays, reduce the frequency of malformations in diabetic mothers.

The only controversy that existed was related to the increased risk of twin pregnancy by supplementing with folic acid which has been shown to be associated with assisted human reproduction procedures (intrauterine insemination or in vitro fertilization) and not with folic acid supplementation.

The most exposed to the risk seem the women between the ages of 18 and 24 who are the least compliant with these supplements and that represent about 1/3 of the births.

Also, at increased risk are patients with epilepsy through the treatments they follow which are also teratogenic and alter the folate metabolism so in their case it is recommended to supplement at least 0.4 mg / day of folic acid! These women have an increased risk of unplanned pregnancies and the fact that antiepileptic drugs reduce the effectiveness of oral contraceptives and they in turn increase the risk of epileptic seizures so that the only safe method of contraception is the barrier (condom).

In women using oral contraceptives there is also a deficiency of folate and it is recommended in their case to start supplementing with oral contraceptive folic acid before discontinuing contraception in order to get pregnant.

In patients with genetic mutations on the MTHFR C677T gene in homozygous form (representing 10-12% of the European population) there is a reduction in the function of this enzyme which is involved in folic acid metabolism by approximately 70% which causes an increase in plasma levels. of homocysteine ​​and implicitly in delays of closure of the neural tube. In heterozygous mutation carriers, the risk is significantly less of these anomalies.

The current consensus provides supplements containing 0.4 to 0.8 mg folic acid / day for all women of reproductive age and 4 mg / day for women with a history of neural tube defects.

Dr. Oana Moise

Specialist obstetrics-gynecologist

Competent obstetrical-gynecological ultrasound

Over-specialization in Assisted Human Reproduction (In vitro fertilization)

Wellborn Medical Network

Tags Folic Acid Pregnancy Questions Folic Acid Pregnancy