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  • Elizabeth Kearney, MS, CGC

Why Folic Acid and Family Health History Matter When Planning for Pregnancy



Many people want to know what they can do to get ready for a safe and healthy pregnancy. Good health may help improve the chances to conceive and lower the risk for pregnancy complications and birth defects. Good nutrition is an important part of a healthy pregnancy, and many people may wonder how diet supplements or prenatal vitamins fit into a healthy diet. The American College of Obstetricians and Gynecologists (ACOG) recommends women planning for pregnancy take 400 micrograms of folic acid daily through a supplement in addition to a nutritious diet. Taking folic acid has been shown to lower the chances for a certain type of birth defect, called a neural tube defect, which happens in about 1 in 500 to 1 in 1,000 babies born in the United States. (Examples of neural tube defects are spina bifida and anencephaly, which are described below.) The recommended amount of folic acid in a supplement is even higher than 400 micrograms if there is already a family health history of a neural tube defect.


What is folic acid?

Folic acid is a form of a B vitamin important for helping the body make new cells. It is found naturally in foods like leafy greens, beans, lentils, broccoli, and more. Some foods found in the grocery store like breads and pastas have folic acid added; in other words, those foods are “fortified”. Adults need folic acid to create new cells, and the folic acid is critical to a baby as it grows and develops.


How do people get folic acid?


As mentioned above, certain foods contain a form of folic acid. The Academy of Nutrition and Dietetics says that leafy greens, beans and lentils, broccoli, asparagus, and citrus fruits are all good sources of folic acid. Also, some foods are fortified or enriched with folic acid, like breakfast cereals or breads. However, it can be difficult to get enough from diet alone. Multivitamins are available without a prescription, and they usually contain folic acid. It is important to check the label to know how much folic acid they contain.


Why does folic acid matter when getting ready for pregnancy?


The most likely outcome of most pregnancies is a healthy baby. Although no prospective parent wants to think about something going wrong with a current or future pregnancy, they may also want to take any common sense steps to be as healthy and safe as possible. One type of birth defect, called a neural tube defect, is among the most common types of birth defects. Many trusted organizations, like ACOG, the Center for Disease Control, the March of Dimes, and the Academy of Nutrition and Dietetics, recommend that women who are considering pregnancy take a folic acid supplement every day to help lower the chances for neural tube defects in their babies.


What are neural tube defects?

The neural tube is the very early form of a baby’s brain and spinal cord. The neural tube is forming around 3-4 weeks of pregnancy, so often a woman does not even know she is pregnant yet.

Without enough folic acid, there is a higher chance that the neural tube will not form properly, leaving a small opening that may cause nerve and brain damage to the baby. Neural tube defects occur in about 1 in 500 to 1 in 1,000 babies born in the United States.

Common types of neural tube defects are called spina bifida or anencephaly. Spina bifida and related neural tube defects vary in how severe they are. Some people with spina bifida have paralysis and need to use a wheelchair and may have bladder control problems. Others may have more mild neural tube defects with limited symptoms. Anencephaly is at the other end of the spectrum; anencephaly is a very severe type of a neural tube defect that prevents normal brain formation. Babies born with anencephaly typically do not survive very long. The chance for these types of neural tube defects can be decreased by taking folic acid before pregnancy and during the early stages of pregnancy.


Are neural tube defects genetic?


The greatest odds for most pregnancies is a healthy baby, but about 3-5% of babies have some type of birth defect or problem with development. Neural tube defects are one type, and neural tube defects can run in family. Neural tube defects show multifactorial inheritance, which means that they result from a combination of many genetic and other factors, or “many factors”. That’s why both family health history and folic acid are important.


To understand multifactorial inheritance, think about a glass of ice water. Pretend that the ice represents the genetic factors, and the water represents non-genetic factors, like diet. If you have a lot of ice, or genetic factors, it won’t take as much water to fill the glass and spill over. If you don’t have much ice, you can add more water before the glass overflows. The same is true with genetic factors for neural tube defects like spina bifida. If a person has many genetic factors, it won’t take as many other factors, like diet, to “spill over” to cause problems with the development of the baby’s brain and spinal cord.


If a person’s family health history includes a close relative with a neural tube defect, that person has a higher chance than the general population to have a child with a neural tube defect.

When should women start taking folic acid when planning for pregnancy?


Planning ahead for pregnancy can definitely help increase the odds for a safe and healthy pregnancy in many ways. Taking folic acid supplements prior to pregnancy is one example. As stated above, the neural tube, which becomes the baby’s brain and spinal cord, is forming very early in the pregnancy at 3-4 weeks. A woman may not even know she is pregnant yet. Therefore, ACOG and the CDC recommend taking folic acid supplements, in addition to a healthy diet, for all women who are at an age where pregnancy is possible. That way, even if a pregnancy happens earlier than planned, the chances of a neural tube defect will be lower.


How much folic acid is needed when planning for pregnancy?


Many trusted organizations like the American College of Obstetrics and Gynecology, the CDC, and the March of Dimes recommend that women take a supplement of 400 micrograms of folic acid daily if they are of an age when pregnancy is possible.

By taking folic acid even before pregnancy, a woman can ensure she has lowered the chance for neural tube defects should she get pregnant. By the time a woman knows she is pregnant, it may be too late to start taking folic acid to lower her chances for a neural tube defect. (However, taking prenatal vitamins throughout pregnancy is also important for the baby’s development.)


Are there reasons to take even more than 400 micrograms of folic acid when planning for pregnancy?


If a couple has a family health history of neural tube defects, it may be appropriate to take more folic acid than what is typically recommended for pregnancy without a family health history of neural tube defects. For example, if a woman or her partner had a neural tube defect themselves or if they already have a child with a neural tube defect, the woman should have a higher dose of folic acid. In that case, ACOG recommends 4000 micrograms, or 400 milligrams, of folic acid per day. It is important to talk with a preconception or prenatal care provider about a prescription for this higher dose of folic acid rather than trying to get that much folic acid without a medical professional’s help.


A common misunderstanding may be that only the woman’s medical and family health history affects how much folic acid is needed in a daily supplement. The family health history of the father also matters.

For prospective parents who are unsure about whether a higher dose of folic acid is needed, or for those who want personalized information about the chance for birth defects, the Pregnancy Planning Family Screen can help. General information about prenatal and genetic screening is available through Mainstream Genomics’ Free Information Guides.



What about folic acid during pregnancy?


A healthy diet, including the right vitamins and minerals, are important to a healthy pregnancy. Therefore, ACOG recommends taking prenatal vitamins during pregnancy. Prenatal vitamins contain folic acid, too.


Summing It Up: Folic Acid, Family Health History, and Getting Ready for Pregnancy


Prospective parents get bombarded with information about pregnancy and advertisements for products and services. It can be hard to find the facts and science, and hearing messages about birth defects can create anxiety. The fact is, most pregnancies will result in a healthy baby. Taking some common sense steps before pregnancy can help ensure a safe and healthy pregnancy.

A 400 microgram folic acid supplement is a well-understood step of prevention against a common birth defect called a neural tube defect.

Multiple medical societies and public health institutions recommend a folic acid supplement of 400 micrograms daily in addition to a healthy diet for women who are of an age when pregnancy can happen. Taking folic acid can reduce the chances for a neural tube defect like spina bifida, and it is a simple, straight-forward step to take when planning for pregnancy. Prospective parents with a family health history of a neural tube defect may need a prescription for a higher dose. Getting advice from a genetic counselor or using the Pregnancy Planning Family Screen will help assess whether additional folic acid is recommended.


Resources:

Nutrition During Pregnancy (ACOG)

Folic Acid (CDC)

Folic Acid (March of Dimes)

What is Spina Bifida (Spina Bifida Association)

Eating Right During Pregnancy (Academy for Nutrition and Dietetics)

Planning for Pregnancy (Center for Disease Control)

Getting Ready for Pregnancy: Preconception Health (March of Dimes)








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