Folic acid – a key to preventing your baby’s risk of neural tube defects |27 October 2017

A new study by the Centres for Disease Control in the US has reinforced previous scientific findings of the need to ensure a sufficient intake of folic acid during the early stage of pregnancy to help reduce the risk of babies being born with defects that are related to a possible lack of folic acid in pregnant women. To help reduce the risk of such occurrences in our local population, the Nutrition Unit at the Ministry of Health tells us what we need to know about this particularly important nutrient.

The term folate is used to describe the group of compounds derived from folic acid. Although they are often used interchangeably, folate and folic acid are different chemically. Folates occur naturally in foods whereas folic acid is synthesized in a lab and found in supplements and fortified foods.

Folate or folic acid, is a B vitamin required by the body to make new cells. Rapid cell division during the very early stage of pregnancy means that more folate is needed before and at the beginning of pregnancy. As such, because the body does not store much of this particular vitamin, women need a regular supply from food as well as supplements in order to remain healthy.

The Nutrition Unit recommends eating fruits and vegetables that are rich in folate, many of which can be found locally at the markets and shops. These include tomatoes, okra (lalo), capsicum (gro piman), eggplant (brenzel), lettuce, Chinese cabbage (bred soudsin), dark-green leafy vegetables (bred paryater, mouroum, lanmar, marten), avocado, banana, orange and mandarin. Tubers like potato, sweet potato, cassava and pulses (beans, peas, lentils) are also rich sources of folate.

The daily requirement of folate is not easily met through food intake only and consequently, supplements are also necessary for pregnant women. This is because the body is able to absorb the folic acid from supplements more readily than folates found in food. The risk of neural tube defects (NTD) which is the abnormal development of the baby’s brain (anencephaly) and spinal cord (spina bifida) can actually be reduced by taking folic acid supplements. The neural tube from which the baby’s brain and spinal cord will develop begins to form during the first few weeks of pregnancy, making it important to get a sufficient daily supply of the nutrient.

But when exactly should pregnant women start taking folic acid supplements? It is advised to start even before and up to the first 3 months of pregnancy, preferably well before you stop taking contraceptives to plan for a baby. However, if you do not take contraceptives and you are planning a pregnancy, it is recommended that you start taking the supplements straight away. After the first three months, folic acid supplements do not need to be continued.

Stephanie Desnousse, principal nutritionist at the Family Health & Nutrition Section, adds that the timing for starting your supplements is very important. “All pregnant women should be informed about the importance of folic acid during their first trimester at their first antenatal appointment. Moreover they are supposed to be given folic acid tablets by the midwife and if it is unavailable they are advised to buy it at a private pharmacy or clinic,” says Mrs Desnousse.

Folic acid supplements are available at the following providers/locations:

• Doctor
• Family Planning clinic
• Antenatal clinic
• Private pharmacies

In terms of dosage, most women require a daily supplement of 400 micrograms, however it is possible that some women need much more if, for example, they have previously had a child with neural tube defects (NTD); their partner has a family history of NTD; they have been taking antiepileptic therapy or they have diabetes, coeliac disease, sickle cell anaemia or thalassemia. Nonetheless, it is important to ensure that your supplements have the right dose by inspecting the label or by asking the provider.

When asked about any possible side effects, Mrs. Desnousse explains that folic acid is likely safe for most people in doses less than 1000mcg (or 1mg) daily. Taking doses of folic acid higher than 1mg can cover up the symptoms of vitamin B12 deficiency, which can eventually damage the nervous system if it is not spotted and treated. This is particularly a concern for older people because it becomes more difficult to absorb vitamin B12 as you get older. Folic acid supplements should only be taken by women who are pregnant or trying for a baby unless given under medical supervision. Women who are not pregnant or planning for a baby should be able to get all the folate they need by eating a varied and balanced diet.

According to Marie-Josee Dangkow, head nurse of Antenatal and Postnatal Wards at the Seychelles Hospital, in addition to pregnancy, alcoholism and stomach problems are also factors that place some women at higher risk of having lower levels of folic acid in their bodies. Despite the fact that minimal cases of birth defects have been observed in Seychelles and cases of neural tube defects & anencephaly are very rare (only 2 cases registered in 2016), Mrs Dangkow also emphasises on the importance for women to seek pre-conception care from their district/private clinic before getting pregnant, saying that folic acid is a must to prevent birth defects. She adds that it is also best to consult your Family Planning nurse, doctor or a midwife for any advice regarding folic acid tablets.

For more information or advice, contact the Nutrition Unit on 4388062 or your local clinic.

References: Nutrition Unit, Ministry of Health; ABC News; NHS