In the first trimester of pregnancy, most women are bombarded with information and it can all be a bit overwhelming.
Try to take in a little bit of information every day, instead of trying to read it all at once.
Today’s little bit of information is on folic acid in pregnancy.
Folate vs folic acid?
In the 1980s, scientists looked at the blood results of women who had babies with neural tube defects, such as spina bifida. The researchers found the mothers were deficient in folate or folic acid and at increased risk.
Further research found supplementing with folic acid or fortified foods before conception reduced the occurrence of neural tube defects.
It needs to be noted that folic acid and folate have significant differences in terms of how the body processes the vitamins.
Folate is a general name used for a group of compounds that have similar nutritional properties.
Folate is a naturally occurring form of vitamin B9. Before it enters the bloodstream, the digestive system converts folate into a biologically active form of B9, called 5-MTHF.
Folic acid is a synthetic folic acid B9 and is also called folic acid supplementation. When it enters the body, it isn’t converted into the active form of vitamin B9 very well. As a result, there can be a build-up of unmetabolized folic acid circulating in the bloodstream.
There have been growing concerns that higher levels of unmetabolised folic acid are linked to health problems, including increased cancer risk, food allergy and B12 deficiency.
Read more about this in Folate – Why It’s So Important Before And During Pregnancy.
Are folic acid and B12 the same thing?
Same but different! Vitamin B12 is found mostly in red meat, fish, chicken and eggs. B12 may be part of a folic acid supplementation but it is not folic acid.
B9 or folate is the naturally occurring folate form of B9; folic acid, on the other hand, is added to a supplement or put into foods and other drinks.
Folic acid benefits
Health experts agree vitamin B9 (folate) is important for the prevention of neural tube defects for pregnant women.
Obviously, the best form of this vitamin is that found in natural sources, such as spinach, avocados, asparagus and other foods.
However, if you’re concerned about not having enough vitamin folate in your diet, and want to take a supplement, it’s best to choose one that doesn’t contain the synthetic form of folic acid (FA).
What are the symptoms of FA deficiency?
Symptoms of folate deficiency may sneak up on you over time and if left untreated you will continue to become more anaemic.
Symptoms of FA deficiency can include:
- Feeling light-headed or faint
- Shortness of breath and having trouble with breathlessness
- Feeling like your heart is beating really fast (palpitations)
- Looking very pale (anaemia)
- Extreme tiredness (fatigue)
- Regular headaches
- Lack of energy (lethargy)
Folic acid for pregnancy
Women were routinely told to supplement with folic acid at the time of conception and during early pregnancy.
It wasn’t long before it became a standard, mandatory practice in many countries to fortify flour and grain products with a synthetic version of folate, called folic acid.
Women who are in their childbearing years are also recommended to take a folic acid supplement.
You can read more in Folic Acid – What You MUST Know Before You Take It.
Who needs folic acid?
All women’s bodies need folic acid to function on a daily basis. If you’re eating enough folate naturally in your diet then you might not need supplementation.
It is recommended you take supplements in pregnancy, due to its known effect in decreasing the risk of neural tube defects.
If you have a problem with the absorption of folic acid, you might need to take particular folic acid supplementation for MTHFR (more information below).
Folic acid dosage
It’s been shown a daily dose of 400mcg can be responsible for causing unmetabolized folic acid to build up in the bloodstream. This is the same amount as the recommended daily dose for women who are planning to conceive or are pregnant.
Recent research has also shown taking folic acid in late pregnancy can increase the risk of allergic outcomes in babies after birth and decrease the risk of neural tube defects.
Read more about this in Folic Acid In Late Pregnancy Can Increase Risk Of Allergies.
Does folic acid help to get pregnant fast?
A folic acid supplement is recommended if you’re trying to conceive. The folic acid supplements can increase your chance of conceiving and, in early pregnancy, reduce the risk of neural tube defects for baby.
Should I take folic acid morning or night?
The folic acid supplements are best taken in the morning. This is mainly to help absorption, as your digestions tend to slow down during the night.
Having the folic acid supplementation in the morning, as most doctors recommend, allows for maximum absorption into your system .
How long should I take folic acid for?
If you are taking a folic acid supplementation, this is usually on the advice of your health provider. Your total folate levels can be monitored by doing blood tests to determine whether you need to continue on the folic acid or whether you need to stop taking the supplement.
Foods high in folic acid
Eating naturally occurring folate will support your levels of folic acid in early pregnancy and beyond. Sometimes, even after eating leafy green vegetables, you might still need folic acid supplementation.
Food choices rich in folate include:
- Proteins, such as cooked beans, peas and lentils
- Veggies, such as spinach, asparagus, lettuce, beets, broccoli, corn, Brussels sprouts and bok choy
- Fruits, such as cantaloupe, honeydew, bananas, raspberries, grapefruit, and strawberries
- Juices, such as orange, canned pineapple, grapefruit, tomato, or other vegetable juices
- Peanut butter
- Sunflower seeds.
Foods to avoid when taking folic acid
Folate disappears when it comes into contact with heat, so consuming too much of overcooked vegetables and fruits will not help your levels.
Drinking alcohol will block absorption of folate and isn’t recommended during pregnancy, as it can harm your developing baby.
People with MTHFR mutations may want to avoid foods that contain the synthetic form of folate, folic acid — though the evidence is not clear that it is necessary or beneficial.
Folic acid and MTHFR
MTHFR is a rather common genetic mutation that can lead to high levels of homocysteine with low levels of folic acid and other vitamins.
MTHFR is the short version of methylenetetrahydrofolate reductase. Testing for MTHFR has become popular of late, due to media coverage.
Some supplements containing 5-MTHF or methyl folate would be worth considering instead of the standard folic acid.
The MTHFR gene mutation inhibits the way the body processes folic acid and other important B vitamins. Changing the supplementation of this nutrient is a potential focus in countering its effects.
Speak with your doctor about the benefits and risks of testing, as well as any other concerns you might have about folic acid supplementation.
You might be interested in reading MTHFR – How 1 in 4 Pregnancies May Be Affected.
Folic acid side effects
Although folic acid allergy is quite a rare condition, it should be suspected in cases of immediate itching and unexplainable anaphylaxis.
Some of the side effects include:
- Nausea, loss of appetite
- Bloating, gas, stomach pain
- Bitter or unpleasant taste in your mouth
- Confusion, trouble concentrating
- Sleep problems
- Depression
- Feeling excited or irritable.
Folic acid allergic sensitization
To minimize the allergy risk or sensitivity to folic acid, you could choose to try desensitization therapy.
This therapy is rarely required, as allergic reactions to folic acid are minimal.
Some women have reported a general skin rash with itching and feeling unwell.
Research folic acid supplements and allergic outcomes in pregnant women
Research presented at the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress suggests folic acid exposure during pregnancy could have an effect in determining whether children develop food allergies, childhood asthma or eczema.
The research comes from the Boston Birth Cohort, which was an ongoing study that followed mother-baby pairs from birth to childhood from 1998 to 2013. One of the focuses of the study was the causes of food allergies in children.
What did the study find?
Researchers tested newborns at birth and early life for levels of unmetabolised folic acid, which occur when the level of folic acid is too high and overwhelms the liver’s capacity to metabolize it.
Newborns who had high levels of unmetabolised folic acid had a higher risk for food allergy later in life compared with newborns with lower folic acid levels.
Of the 1,394 children included in the study, 507 had a food sensitization and 78 had a food allergy.
The researchers believe increased levels of unmetabolised folic acid could be due to increased exposure to folic acid in utero or to underlying genetic differences.
