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Folic acid, also known as vitamin B9, must be supplemented during pregnancy, pregnancy planning and breastfeeding. The scientific and medical community agree on this point. On the basis of numerous scientific studies, the Polish Society of Gynecologists and Obstetricians has developed recommendations for folic acid supplementation in women from various risk groups for fetal defects. Why is folic acid so important in pregnancy?

Folic acidis a key element in the proper development of the fetus and the newborn. Folates are very much involved in the rapid cell division that takes place during fetal life from the very first moments of pregnancy. They participate in DNA synthesis, and their deficiencies in pregnancy are associated with a higher risk of fetal neural tube defects (NDT), fetal growth disorders, heart defects, urinary tract defects, limb defects, cleft lip and palate, and Down's syndrome.

Folic acid in pregnancy - the role and effects of deficiency

Randomized controlled trials found that the risk of NDT was reduced by 100% in women who take 0.8 mg of folic acid per day during the peri-conception period.

Insufficient supply of folic acid is also dangerous for the mother. It can lead to thrombosis and megaloblastic anemia. It increases the risk of abnormal transformation of homocysteine ​​into methionine, causes hyperhomocysteinemia, which leads to atherosclerosis of blood vessels and the brain, and thus to many diseases of the cardiovascular system and cognitive disorders.

Hyperhomocysteinemia also affects the blood supply to the placenta, which may result in inhibition of fetal growth and the abnormal development of the nervous system.

Folic acid deficiency is also the cause of recurrent miscarriages and pre-eclampsia.

Folic acid in pregnancy - dosage

Folic acid supplementation should be started at least 12 weeks before pregnancy . It takes this time for the cells to saturate themselves with folic acid. For every woman planning a pregnancy, this is very important information.

Therefore, supplementation with folic acid should be considered not only by women who are actively trying to get pregnant, but by all womenchildbearing problems, which presuppose having children.

In most women, supplementation is used at least 12 weeks before pregnancy, throughout pregnancy and throughout lactation.

The duration of pre-contraceptive supplementation is slightly different in women at high risk of fetal neural tube defects (NTD).

The recommended dosage of folic acid during pregnancy varies depending on the risk group to which the woman belongs.

There are three risk groups as follows:

  • Low

There are he althy women in the low risk group with no family history of fetal defects.

Recommended dosage:0.4 - 0.8 mg / day of folic acid in the first trimester of pregnancy, then 0.6 - 0.8 mg / day in the second and third trimester and during lactation

  • Indirect

The intermediate risk group includes women with pre-eclampsia or intrauterine growth restriction in a previous pregnancy or a family history of these abnormalities.

Women at risk are also those suffering from:

  • type 1 diabetes or type 2 diabetes,
  • ulcerative intestine,
  • Crohn's disease,
  • celiac disease,
  • liver failure,
  • kidney failure,
  • obesity,

and women:

  • after bariatric surgery,
  • taking antiepileptic drugs, metformin, methotrexate, cholestyramine or sulfalazine,
  • smoking cigarettes,
  • abusing alcohol,
  • with reduced activity of MTHFR - an enzyme involved in the metabolism of homocysteine ​​and folic acid. Reduced MTHFR activity may occur in as much as 50% of the female population. In their case, supplementation with active forms of folic acid is essential.

Recommended dosage:0.8 mg / day of folic acid (including metabolically active folates in the form of calcium s alt L-methyltetrahydrofolate ([6S] -5-MTHF)) and vitamin B12 (the recommendation does not specify exactly how much vitamin B12; general recommendations for pregnant women say that the requirement is 2.2 μg during pregnancy and 2.6 μg during lactation).

  • High:

The high-risk group includes women with a previous pregnancy or a neural tube defect (NTD) in the mother, father or their offspring

Recommended dosage:4 mg / day of folic acid at least 4 weeks before the planned pregnancy and during the first trimester of pregnancy, then 0.6 - 0.8 mg / day in II and IIItrimester and during lactation

It is advisable to take metabolically active folates in the form of calcium s alt L-methyltetrahydrofolate ([6S] -5-MTHF) and vitamin B12 (the recommendation does not specify how much vitamin B12 exactly; 2.2 μg during pregnancy and 2.6 μg during lactation)

Can you overdose on folic acid while pregnant?

Folic acid in dietary supplements is most often in an inactive form and requires metabolism. With its high doses, and at the same time insufficient amount of vitamin B12, which participates in the metabolism of folate, the active form of folic acid - 5-methyltetrahydrofolate - is not formed from part of the folic acid.

Unchanged folic acid contributes to hyperhomocysteinemia and disorders of the immune system.

Excess folic acid is dangerous for pregnancy and later life of the child. It increases the risk of early pregnancy damage and the development of insulin resistance, type 2 diabetes and childhood obesity.

Folic acid doses higher than those recommended for a given risk group should not be taken to avoid the risk of he alth complications.

Folic acid in pregnancy - sources in the diet

A diet, even rich in folic acid products, is not able to cover the needs of pregnant and breastfeeding women. A diet rich in folate and folic acid usually provides 150 to 250 μg of folic acid.

It is recommended to ensure a high supply of folate from food, despite supplementation, and not to ignore the nutritional aspect.The best sources of folic acid arevegetables, mainly leafy greens, as well as yellow-orange and herbs. Next are nuts and seeds, cereal grains, as well as liver, eggs and yeast.

Meat, cold cuts and fish provide only small amounts of folic acid . You should also know that heat treatment causes a loss of 50 to 80% of folic acid. Therefore, we will benefit much more by eating raw vegetables and fruits.

Vitamin C and B12 deficiencies cause disorders of folic acid metabolism . Therefore, it is important that the diet also provides these nutrients. Vitamin C is common in vegetables and fruits, and B12 in animal products - meat, fish, eggs and dairy.

Foods rich in folic acid are :

  • vegetables : chickpeas, white beans, spinach, parsley, parsley root, Brussels sprouts, kale, broccoli, kale, lettuce, asparagus, cabbage, wheat germ, pepper
  • fruit : bananas,strawberries, cherries, kiwi, oranges, raspberries
  • nuts, seeds, grains : sesame, sunflower seeds, peanuts, walnuts, brown rice, wholemeal bread, graham bread, wheat flour
  • animal products : liver, eggs, fresh salmon.

See which vegetables contain the most folic acid!

See the gallery of 10 photos

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Pregnancy