Confused about Folic Acid?
There is a resounding agreement in the medical world that having adequate folate, or folic acid, is vital for a healthy pregnancy. But why? What is folate? Where do you find it?
Folate is the umbrella term used to describe several different types of the vitamin B9, and the term is often used interchangeably with folic acid. However, if we are being scientific: folic acid is a specific type of B9 vitamin, which is generally man-made, whereas the term folate will cover the vitamin that occurs naturally in our foods. There are also several other types of B9, though they are types of the same vitamin, the different forms have their pro’s and con’s. The main drawback to folate (which sounds enticing as the ‘natural form’), is that it is not very chemically stable. This means that even foods that are a good source of folate when raw may lose most of their folate stores when they get cooked, so there is less that can be absorbed by your body. Foods that naturally contain folate include broccoli, asparagus, green leafy veg, peanuts, sunflower seeds and eggs.
On the flip side, folic acid (the synthetic vitamin) is much more chemically stable, and not destroyed in cooking. That is why it is used to fortify flour, which may be found in bread, pasta and cereals.
But why do you need it?
In the body, folic acid is used for many different processes, these include forming healthy red blood cells, metabolising proteins and forming DNA. Due to their collaborative role in forming healthy red blood cells, folate deficiency and iron deficiencies are often closely linked.
Folate is also known to reduce risks of neural tube defects, such as Spina Bifida, in a developing foetus. Because the neural tube develops very early on in pregnancy, it is recommended to supplement folic acid prior to becoming pregnant. Though, with 45% of pregnancies in the UK being ‘unplanned’, it is understood that preconception nutrition is not often considered, and therefore supplementation of folic acid is lacking.
Guidelines currently recommend 400mcg daily for 3 months prior to becoming pregnant in healthy women. This is available to buy ‘over the counter’ in most pharmacies and supermarkets. There is no significant evidence that the less expensive branded supplements are any less effective than the more expensive branded ones. The recommended dose is increased to 5mg per day for one month prior to conception in some circumstances - for example if you have a BMI greater than 30, have a family history of neural tube defects, or have diabetes or coeliacs disease. It is useful to talk to your Doctor if you are trying to conceive, to make sure you are having the correct dose.
Once you have become pregnant, guidelines state that you should keep taking folic acid daily for the first trimester (12 weeks). New research shows that there may be some benefits to the foetal brain development if supplementation continues past the first 12 weeks, however, there is not yet enough research or conclusive enough evidence base to recommend this.
Similarly, though there is not enough research for a conclusive evidence base, it has been found in some recent studies that having adequate folate status was linked to lower rates of post-partum depression. This should be investigated further, but is an interesting consideration.
There has been discussion in the medical science world that taking higher dose folate supplements for a long period of time could mask other deficiencies - so they go unnoticed. One example of this is B12 deficiency, which could be detrimental to the development of the foetus. This was primarily of concern in women who have been taking a high dose for a long period of time, such as if there is a long struggle with infertility. If this is a concern for you, talk with your Doctor or Dietitian about having a lower dose or break, perhaps in line with breaks in IVF cycles.
References:
DOI: 10.1136/jcp.55.10.754
DOI: 10.1111/1471-0528.15386
DOI:10.1186/s12916-019-1432-4
DOI: 10.1016/j.jad.2018.02.004.
DOI: 10.1016/S0140-6736