The necessity of Folic Acid During Pre Conception and Pregnancy

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There are specific nutritional aspects in the preconception period, which are important for both maternal and fetal health.

In particular, folate supply is essential to support healthy fetal development.

Folates comprise a group of substances that belong to the B vitamins. Folate is also known as vitamin B9.

It is essential for numerous body functions. The human body needs folate to synthesize repair and methylated DNA. Folate is especially important in aiding rapid cell division and growth, particularly during pregnancy. And during early childhood.

Children and adults require folate to produce healthy red blood cells and to prevent anemia.

Humans cannot synthesize folate within their bodies. Therefore, folate is essential nutrients that have to be supplied through the diet regularly to meet the body’s requirements of folic acid

Folic acid is the synthetic form of folate, and it is found in supplements and fortified foods.

Natural folate is rather unstable and quite a bit of content is lost during cooking and food preparation.

Also, natural folate has a low bioavailability only about 50% or half of the natural folate is consumed from foods are absorbed and taken up into the body.

In contrast, the synthetic form of folic acid is rather stable, and almost the entire intake is absorbed into the body

Bioavailability dietary intake of folate is described using a dietary folate equivalent, or DFE. One microgram of DFE is equal to one microgram of food folate, or half a microgram of folic acid if taken on an empty stomach or 0.6 micrograms of folic acid if supplied with meals.

In 2015 the World Health Organization established population-specific cut-off values for red blood cell folate concentration to determine adequate folate status in women of reproductive age.

The aim was to effectively prevent the occurrence of neural tube defects in population or population level, red blood cell folate levels in women of reproductive age should be above, 906 nanomoles per liter to achieve an optimal reduction in neural tube defects or NTDs.

The amount of folate-rich food required per day to meet the requirements is so great, so the WHO as well as the majority of international recommendations, stipulate folic acid supplementation in addition to the folate-rich diet.salad 2756467 640 1

Folate and folic acid derive their names from the Latin word folium, which means leaf.

Folate naturally occurs in many foods and especially plentiful in dark green leafy vegetables, legumes, citrus fruits, and juices.

Folate is also common in bread and cereals that contain flour enriched with folic acid.

Folate is required for cell division, and it plays a major role in the prevention of NTDs. NTDs are serious congenital malformations that result from the failure of a neural tube to close during early embryogenesis between 18 and 26 days after conception.

So it is Paramount that an adequate amount of folic acid is already consumed before conception to achieve adequate tissue concentrations, at the very beginning of pregnancy.

The timely intake of folic acid supplementation before conception is emphasized by the number of unplanned pregnancies. In 2006 49% of pregnancies in the US, were reported to be unintended

Folic acid supplementation after the diagnosis of pregnancy is far less effective, and usually too late to effectively reduce the risk of NTDs because the closure of the neural tube is completed usually by the time when a woman starts to know that she’s expecting a child.

The protective effects of folic acids in the prevention of neural tube defects are well proven and have been established by several randomized control trials.

The 2010 Cochrane Review of folic acid in the preconception and early pregnancy period in the prevention of neural tube defects, and other defects such as cleft palate concluded that the folic acid was beneficial, without any evidence of harm for the mother and baby.

And around 72% of neural tube defects could be prevented by folic acid during this period, either alone or in combination with other vitamins and minerals, an excellent example of the benefits of folic acid fortification of flour comes from the United States.

In the United States folic acid fortification was first introduced in 1996, followed by mandatory fortification from 1998 with 140 micrograms of folic acid, per 100 grams of flour, and immediately following this, the prevalence of neural tube defect births began to decline.

Indeed, folic acid fortification of flour is now estimated to prevent thousands of affected neural tube defect births annually. And this success has led to other countries globally introducing mandatory folic acid fortification and 86 countries worldwide now have such legislation in place.

Because the increased needs in early pregnancy are very difficult to meet with dietary intake alone. The most widespread strategy used is a supplement of a multivitamin preparation containing 400 to 800 micrograms of folic acid, even in the case of fortified foods.

Many national and international nutrient requirements setting bodies recommended the intake of 600 micrograms per day of dietary folate during pregnancy. However, to reduce the risk of NTDs, it is recommended that women in addition to the dietary folate intake also consume 400 micrograms per day of folic acid in the form of a supplement or with fortified foods.

Folic acid intake should be started at least one month before conception and continued until at least 12 weeks of pregnancy. After the tribes week of pregnancy women should increase their folic acid supplement dosage to about 800 micrograms per day.

Not only pregnant women but all women of reproductive age should take a daily folic acid supplement.

This is an attempt to reduce the risk of neural tube defects in unplanned pregnancies, as well as planned pregnancies.

For women with a history of children with neural tube defects, for women with diabetes, or a woman who receives anticonvulsant treatment, as well as for obese women, the recommended dose is four to five milligram of folic acid per day.

High-Risk women should consult a doctor to ensure the correct guidelines for folic acid supplementations

Folic acid supplementation in the preconception period, effectively reduces the risk of recurrent NTDs, by about 70%.

So in inclusion in preconception preparation, as well as for all women of childbearing age folic acid should be considered an essential part of prenatal counseling.



AT LEAST 400 mg/day

AT LEAST 400 pg/day

400-800 ug/day

4000-5000 ug/day

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