Each year, 300,000 babies are born with Neural Tube Defects (NTDs) worldwide*1. NTDs are brain and spinal cord developmental defects that happen during early fetal development. Most of these cases are preventable, and Folic Acid (FA) plays a critical role.

What is Folic Acid?

Folic Acid, or FA, is the synthetic form of Folate, the natural form of Vitamin B9. Folate is essential for cell production and growth, DNA formation, and supporting functions of the nervous and immune system. Folate is important for producing and maintaining red blood cells, so a deficiency can cause anemia. FA deficiency can also lead to a higher risk of depression, memory problems, fatigue and loss of appetite. Alcohol abuse, frequent use of antibiotics, diuretics and oral contraceptives, as well as poor diet and smoking can deplete the body’s folate stores. Although the human body needs folate, it cannot produce it and must receive it from foods and dietary supplements. Folate can be found naturally in dark leafy vegetables such as spinach, brussel sprouts and lettuce, as well as in lentils, oranges, milk and whole wheat bread.

What is Folic Acid’s role in pregnancy?

Folate is critically important during pregnancy as it reduces the risk of premature birth. It is also essential for spinal cord growth; a Folate deficiency could lead to severe fetal defects and complications, such as miscarriage or low birth weight. Due to its critical role in fetal development, FA is found in most prenatal vitamins or as a supplement by itself. It is recommended that pregnant women should consume folate-rich foods and take appropriate amounts of FA supplements under the direction of their physician.

What causes NTDs and what role does FA play?

FA is essential for neural tube development and closure, which happens by the 28thday of conception. The neural tube is a structure from which both the brain and the spinal cord will subsequently form. If neural tube fails to close, the embryo develops an NTD.

What are some common NTDs?

A common NTD of the brain is anencephaly, a serious birth defect in which part of the brain may be missing. Sadly, babies born with anencephaly do not survive past infancy. Spina Bifida is a birth defect in which the baby’s spinal column does not properly close during development, leaving the spinal cord exposed. Children with Spina Bifida have mobility and skin problems, and will need surgical interventions.

How can FA prevent NTDs?

To prevent NTDs from occurring, it is essential that pregnant women should take FA supplements during the first 4 weeks following conception when the brain and spine develop. Since a lot of women might not be aware of their pregnancy at that stage, it is recommended that all women who are planning to get pregnant take FA supplements. There are no side effects for taking FA for a lengthy period of time; in fact, research has shown that taking FA for at least 12 months before becoming pregnant could reduce the risk of premature birth by over 50%*2. Additionally, there is conclusive evidence that adequate consumption of FA during pregnancy can significantly reduce NTD occurrence. Studies have shown that 400μg of FA prevents the occurrence of over 50% of NTDs if it is taken before conception and throughout the first trimester of pregnancy*3. Several countries such as the United States, Canada, China and South Africa have launched a mandatory FA fortification of dietary foods such as staple cereal grains, bread, pasta and flour among others. A study examining the results of FDA-required fortification in the United States from 1995-2011 has reported that the birth prevalence of NTDs has decreased by 35% since FA fortification was introduced in 1998*4.

What is the recommended amount of FA supplement?

Several prominent health organizations, such as the CDC, recommend a daily amount of 400μgof FA to be consumed by pregnant women or women wishing to become pregnant. If there is a family history of a NTD, the recommended daily amount increases to 4000μg.

Always discuss with your healthcare provider the right supplements and dosage for you.

References

*1 Christianson A.L. et al. (2006) ‘Global report on birth defects: the hidden toll of dying and disabled children’. White Plains (NY): March of Dimes Birth Defects Foundation.

*2 Callaway L., et al. (2009) ‘Folic Acid supplementation and spontaneous preterm birth: Adding grist to the mill?’ Plos Medicine 6(5): e10000077

*3Centers for Disease Control and Prevention. (1992) ‘Recommendations for the use of folic acid to reduce the number of cases of Spina Bifida and other neural tube defects’. MMWR. 41: 1-8.

*4 CDC (2015) ‘Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification – United States, 1995-2011’. MMWR Morbidity and Mortality Weekly Report. 64(01); 1-5.