What Do Other Countries Do
Mandatory fortification with folic acid
- USA has had mandatory fortification of all cereal/grain flours with folic acid since 1998.
- Canada white flour and pasta has been mandatorily fortified since 1998.
- Chile introduced mandatory fortification of flour in 2000.
- Australia introduced mandatory fortification of non-organic bread-making wheat flour in late 2009.
Food Standards Australia New Zealand develops food standards for both New Zealand and Australia.
Voluntary fortification with folic acid
- European countries to date, none have introduced mandatory fortification with folic acid.
- UK and Ireland continue to permit voluntary fortification of certain foods with folic acid.
Recommendations for women planning a pregnancy
USA, Canada, Australia, UK and Ireland recommend women planning a pregnancy take a folic acid tablet in the range of 400500 µg for women at low risk of a NTD affected pregnancy.
Folic Acid And Female Fertility
Women who don’t get enough folic acid in their diet are at a higher risk of having a baby with a neural tube defect. When we consider how a baby beginsa single cell that divides and dividesit makes sense that folic acid could help ensure the cell division, and therefore fetal development goes well.
Neural tube defects, which occur in about 3,000 pregnancies per year in the United States, include spina bifida, anencephaly, and encephalocele. At best, these birth defects can lead to lifelong disability, and at worst, they can lead to early death.
If you have a family history of neural tube defects, you have an even higher risk of having a child with one of these birth defects.
While folic acid can’t eliminate these birth defects, folic acid supplementation started before conception and continued through early pregnancy has been found to cut the occurrence of these birth defects by up to 60 percent. Other possible benefits of folic acid supplementation include:
- A lower the risk of congenital heart defects
- A lower risk of preterm birth and a lower risk of low-birth-weight babies
- Increased progesterone levels and a lower risk of irregular ovulation
There are many good reasons for women trying to conceive to be sure they get enough folate.
Taking Folic Acid When Youre Trying To Get Pregnant
Women who are trying to get pregnant or who are capable of becoming pregnant should take 0.4 mg of folic acid per day. The effects of higher dosages of folic acid are not well known, but could complicate the diagnosis of a vitamin B12 deficiency. To learn more about the B12 vitamin and pregnancy, read How Vitamin B12 Affects Fertility.
So, women who are not pregnant yet should be careful NOT to take more than 1 mg per day of folic acid except under supervision of a doctor or ob-gyn. If you have had a baby in the past who had a neural tube defect, then your next baby is at a higher risk of future health problems.
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How Much Folic Acid Should I Take While Trying To Get Pregnant & During Pregnancy
You can call folic acid as the pregnancy super vitamins because of folic acid benefits! Use the prenatal vitamins along with the folic acid, before as well as during the days of pregnancy. It helps in preventing the defects related to the spinal cord and brain in babies and a few more important benefits. It is highly recommended to use them each day before and during pregnancy.
Risks Of Folic Acid Supplementation
You can have too much of a good thing. Unless your doctor prescribes it, your daily supplements shouldn’t include more than 1,000 mcg of folic acid.
Taking large doses of folic acid may cover up a vitamin B-12 deficiency, which can cause irreversible damage if not caught early on. Your doctor should test your B-12 levels before putting you on high dose folic acid supplements.
Theres also a concern that high doses of folic acid may actually harm DNA synthesis in sperm.
Folic acid may interact with other medications. For example, folic acid may reduce the effectiveness of the anti-seizure drug phenytoin. Also, some fertility blends include herbs that can interact with fertility drugs. So be sure to speak with your doctor before beginning any supplementation.
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Some People Need A Higher Dose Of Folic Acid
If you have a higher risk of having a pregnancy affected by neural tube defects you will be advised to take a higher dose of 5mg folic acid.
You may have a higher risk if:
- you or your partner have a neural tube defect
- you have had a previous pregnancy affected by a neural tube defect
- you or your partner have a family history of neural tube defects
- you have epilepsy
- you are a heavy drinker.
To get a higher dose talk to your doctor because 5mg tablets arent available without a prescription.
Optimizing Dietary Folate Intake
Following a healthy eating pattern and choosing foods that are rich in nutrients helps women meet their requirement for folate and other nutrients. To promote adequate dietary folate intake:
- Encourage women to use Canada’s Food Guide. It describes a healthy eating pattern that is rich in dietary folate. Following Canada’s Food Guide will also help women meet their needs for other nutrients and can help them achieve overall health.
- Promote use of tools such as My Food Guide Servings Tracker. This can help women keep track of the amount and type of food they eat each day and compare their intake to Canada’s Food Guide.
- Encourage women to include grain products fortified with folic acid each day, such as enriched bread or enriched pastaFootnote 11. They can make informed choices, by looking for the term ‘folic acid’ in the ingredient list.
- Encourage women to have legumes, such as beans or lentils, often and eat at least one dark green vegetable, such as peas or romaine lettuce, each day.
- Refer women to a Registered Dietitian if they have a significantly restricted food intake. This can happen when women exclude an entire food group or have severe nausea or vomiting. These women can benefit from comprehensive nutritional assessment and counselling.
- Refer nutritionally at-risk women to services or programs that can help. The Canada Prenatal Nutrition ProgramFootnote 12 .Website provides contact information for programs and services for vulnerable pregnant women.
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How To Get Enough Folic Acid To Prevent Neural Tube Defects
In addition to eating foods with folate from a varied diet, women can get folic acid from
- Taking a vitamin that has folic acid in it:
- Most vitamins sold in the United States have the recommended daily amount of folic acid that women need for the prevention of neural tube defects. Vitamins can be found at most local pharmacy, grocery, or discount stores.
If taking folic acid for reasons other than neural tube defect prevention, talk to your healthcare provider.
What Is Folate/folic Acid
Folate is an essential B vitamin and is found naturally in leafy vegetables, citrus fruits, wholemeal bread, yeast, liver and legumes.
Folic acid refers to pteroylmonoglutamic acid and is the synthetic form of folate. Folic acid is used in dietary supplements and fortified foods and beverages. It is more bio-available and stable, than naturally occurring food folate.
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Not Getting Enough Folate
Because the body has a high demand for folate, women may not get enough of this nutrient during their childbearing years . Women who are at higher risk include those who:
- are not taking the recommended folic acid supplement,
- are on restricted diets ,
- have a lower socio-economic status, and
- are experiencing food insecurityFootnote 5.
Previous Pregnancy With Ntd
While the risk of NTDs in the general population in North America is currently less than 1 per 1000 pregnancies, the risk in women with previous pregnancies with NTDs is 40-fold higher, at around 4%. In the breakthrough randomized controlled trial by Wald et al, 4-mg/d of folic acid decreased this risk by 75% compared with women who did not receive folic acid supplementation. Therefore, it is critical to provide the available 5-mg/d folic acid supplement to women with previous NTD-affected pregnancies.
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Are Folate And Folic Acid The Same Thing
The terms folate and folic acid are often used interchangeably, even though they are different. Folate is a general term to describe many different types of vitamin B9.
Types of folate can include
- Dihydrofolate
- 5, 10-methylenetetrahydrofolate
- 5-methyltetrahydrofolate
Food fortification is a way to add vitamins or minerals, or both, to foods. Some rice, pasta, bread, and breakfast cereals are fortified with folic acid. These foods are labeled enriched. Folic acid is a specific type of folate that does not generally occur naturally.
Folic acid is ideal to use for food fortification. It is more stable than types of natural food folate. Heat and light can easily break down types of natural food folate. Folic acid is better suited for food fortification because many fortified products, such as bread and pasta, are cooked.6
CDC recommends that women of reproductive age who could become pregnant consume at least 400 micrograms of folate every day. However, its difficult to get 400 mcg of folate through diet alone. You can get 400 mcg of folic acid each day by taking a vitamin with folic acid in it, eating fortified foods, or a combination of the two, in addition to consuming a balanced diet rich in natural food folate.
Folic Acid: Start Taking Before You Get Pregnant
During pregnancy, a body needs to increase nutritional values. During pregnancy, the need for nutritional value that a body needs increases. It is shaped according to needs of a growing baby and pregnancy. Folic acid is a group of vitamins that expectant mothers should start before getting pregnant.
Folic acid is very important for baby development. It functions in a body such as protein synthesis, cell proliferation, and complete functioning of bone marrow. Folic acid is not stored in the body. So it must be taken every day.
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Promoting The Use Of Folic Acid Supplementation
According to Canadian survey data, 58% of women said they took a multivitamin containing folic acid or a folic acid supplement in the three months before becoming pregnant . It has been shown that the use of supplements is influenced by economic status and educational background . For instance, the use of folic acid supplements before pregnancy in Canada was lowest among women in lower-income households, among women with less than high school graduation, and among immigrant mothers . Women with unplanned pregnancies, mothers under the age of 25 and single mothers are also less likely to supplement with folic acid .
Although the majority of Canadian women take folic acid supplements in the three months before pregnancy, continued public health efforts are needed to promote awareness of the importance of folic acid supplementation for all women of childbearing age. To avoid increasing socio-economic inequalities in folic acid use, interventions should provide practical support to vulnerable groups .
How To Take It
You can take folic acid with or without food. Swallow the tablets whole with a drink.
If you’re taking folic acid as a liquid, it’ll come with a plastic syringe or spoon to help you measure out the right dose.
If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give you the right amount.
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How Can You Get Folic Acid From Food
You can get folic acid from food. Some foods are fortified with folic acid. Fortified means a food has folic acid added to it. Check the product label to see how much folic acid you get in each serving. Look for the word fortified or enriched on labels on foods like:
- Bread
- Flour
- Pasta
- Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco shells, tamales and pupusas
- White rice
Some fruits and vegetables are good sources of folic acid. When folic acid is found naturally in food its called folate. Foods that are good sources of folate are:
- Beans, like lentils, pinto beans and black beans
- Leafy green vegetables, like spinach and Romaine lettuce
- Asparagus
- Peanuts
- Citrus fruits, like oranges and grapefruit
- Orange juice
Its hard to get all of the folic acid you need from food. Even if you eat foods that have folic acid in them, take your vitamin supplement each day, too.
When Should I Start Taking Folic Acid
Birth defects occur within the first 3-4 weeks of pregnancy. So its important to have folate in your system during those early stages when your babys brain and spinal cord are developing.
If you talked to your doctor when you were trying to conceive, they probably told you to start taking a prenatal vitamin with folic acid. One study showed that women who took folic acid for at least a year before getting pregnant cut their chances of delivering early by 50% or more.
The CDC recommends that you start taking folic acid every day for at least a month before you become pregnant, and every day while you are pregnant. However, the CDC also recommends that all women of childbearing age take folic acid every day. So youd be fine to start taking it even earlier.
If you picked out your own prenatal vitamin, take it to your OB once youre pregnant to make sure it has the recommended amounts of everything you need, including folic acid. All prenatal vitamins are not the same and some may have less or more of the vitamins and minerals you need.
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Folic Acid In Other Conditions
Folic acid is also used alongside methotrexate treatment in people with severe Crohns disease, psoriasis, and arthritis. When it is used in these medical conditions, folic acid is taken on a different day of the week to methotrexate. It is taken to reduce the side effects which can be caused by methotrexate.
The Importance Of Folic Acid In Female And Male Fertility
Leyla Bilali, RN is a registered nurse, fertility nurse, and fertility consultant in the New York City area.
If you’ve been looking at supplements for fertility, you’ve likely come across recommendations for folic acid. One of the B-vitamins, folate is needed for the development of red blood cells and DNA production. Folate also plays an important role in cell division. Low folate blood levels are associated with a form of anemia.
Folic acid is clearly an essential nutrient in the body. But can folic acid help you conceive? Should men also be taking folic acid? Should you take a supplement, or can you get what you need from diet alone?
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Taking Folic Acid Before Pregnancy
It is important to start taking folic acid supplements at least two to three months before you conceive until the 12th week of pregnancy. The reason behind this is because birth defects usually happen within the first three to four weeks of pregnancy.
So, it is of extreme importance to have folate early on while the babies brain and spinal cord are in the development stage.
Taking folic acid two months before you stop contraception can also get you pregnant faster. In addition, a study even showed that women who took folic acid for a year before they got pregnant cut their chances of early delivery by 50% or more.
Moving on, when it comes to folic acid supplementation before pregnancy and the possibility of conceiving twins, research was conducted to see if there was a significant connection. The said research showed that out of the 38,151 who were pregnant, 395 gave birth to twins.
According to the stats, twin births made up 0.78% in the group that was not supplemented, while the chances of twin pregnancies with preconception supplements were 1.52%. This shows that taking folic acid supplements before pregnancy caused a slight increase in the incidence of a twin pregnancy.
Folic Acid Before And During Pregnancy
Its important to take a 400 micrograms folic acid tablet every day before you’re pregnant and until you’re 12 weeks pregnant.
Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.
If you did not take folic acid before you conceived, you should start as soon as you find out you’re pregnant.
Try to eat green leafy vegetables which contain folate and breakfast cereals and fat spreads with folic acid added to them.
It’s difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it’s important to take a folic acid supplement.
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Vitamin C In Pregnancy
Vitamin C protects cells and helps keep them healthy.
It’s found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.
Good sources include:
- soya drinks with added calcium
- bread and any foods made with fortified flour
- fish where you eat the bones, such as sardines and pilchards
What If I Forget To Take It
Missing 1 or 2 doses probably will not matter. But if you keep forgetting to take your folic acid, or you do not want to take it, speak to your doctor.
If you stop taking your folic acid:
- in pregnancy – the risk of your baby having neural tube defects may increase
- for folate deficiency anaemia – your symptoms may get worse or new symptoms may appear
- to reduce the side effects of methotrexate – you’ll be more likely to get side effects from methotrexate
If you forget to take folic acid:
- once a day – take your missed dose as soon as you remember. If it’s nearly time for your next dose, skip the missed dose and just take your next dose as normal. If you remember on the day you take your methotrexate, wait a day and take your missed dose the following day.
- once a week – take your missed dose as soon as you remember, unless you take methotrexate that day. If you remember on the day you take your methotrexate, wait a day and take your missed dose the following day. After this, go back to taking your weekly dose on your usual day.
Never take 2 doses to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
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