Folic Acid

Folic acid is used to make the extra blood your body needs during pregnancy. All women should consume 0.4 mg of folic acid a day.

When should I start taking folic acid?

You should start taking folic acid prior to getting pregnant, even if you are not trying to conceive. Neural tube defects usually develop very early in pregnancy (18-30 days after conception) often before a women even knows that she is pregnant. If you find you are pregnant and have not been taking folic acid, you may start now to help prevent any neural defects that would develop in the first three months of pregnancy.

What are the risks of not taking folic acid?

The absence of folic acid increases the possibility of a neural tube defect which are defects in the development of the spinal cord.

• Spina bifida is a condition in which the spinal cord is exposed. If the vertebrae (bones of the spinal column) surrounding the spinal cord do not close properly during the first 28 days after fertilization, the cord or spinal fluid bulge through, usually in the lower back.
• Anencephaly is a condition in which infants die shortly after birth because most of the brain is absent.

What foods contain folic acid?

Since more than half of pregnancies are unplanned, the Food and Drug Administration has taken steps to fortify food so that all women of childbearing age get a daily dose of folic acid. The following foods can help you obtain your recommended amount of folic acid:

• Leafy green vegetables such as a large spinach salad
• Citrus fruits, such as a tall glass of orange juice
• Beans
• Breads
• Cereals
• Rice
• Pastas

A daily vitamin with folic acid is also suggested since the food listed above may not contain enough of the supplement to meet the requirement.

How do I know if I am at risk for having a baby with neural defects and how can I prevent this from happening?

Women who are at the greatest risk are those that have had a previous pregnancy that involved a neural defect. Women who are not eating a balanced diet that includes folic acid are also at risk.

The best way to prevent neural defects is to take the recommended 0.4 mg of folic acid daily, for one month before conception and during the first three months. Multivitamins that include folic acid should only be used as a supplement. You cannot take too much folic acid, but you can over-dose on the other vitamins contained in multivitamin formulas.

How are neural tube defects diagnosed?

Neural tube defects are detected through an AFP (Alpha-fetoprotein test) a blood test administered at 16-18 weeks gestation. The test measures alpha-fetoprotein, a substance produced by the fetus and secreted into the amniotic fluid, eventually entering the mother's blood. The level of AFP in mother's blood peaks at about 30-32 weeks. Abnormally high amounts of AFP may indicate a baby has a neural tube defect.

What are other reasons for an elevated AFP?

An elevated AFP could mean the mother is carrying twins or that there is a problem with the placenta. Women with diabetes or liver disease may also have an elevated AFP. However, an elevated AFP could also mean there are birth defects in the fetus such as severe kidney disease, liver disease, esophageal or intestinal blockage, Down Syndrome, urinary obstruction, or osteogenesis imperfecta (fragility of the baby's bones)

If I have an elevated AFP, what other tests can I expect?

• A second AFP test
• An ultrasound
• Amniocentesis

Reprinted with permission from American Pregnancy Association