Folic acid is the most common vitamin deficiency in the world. This is very concerning since it is critical to the proper development of a baby in the very first weeks of pregnancy. An estimated 1-2 in 1000 babies born in the United States are born with the neural tube defect known as spina bifida. Folic acid supplementation has been shown to reduce the incidence of neural tube defects by up to 80%.

50% of all pregnancies are unplanned. It is important that you begin taking folic acid before pregnancy occurs, to help support proper development of your baby’s spinal column should you become pregnant. Folic acid also known as folate, folacin and vitamin B9, has also been found to support proper development of a growing fetus.

How Folic Acid Helps Your Body Create a Healthy Baby

Folic acid supplementation is essential in preventing spina bifida. During the first 28 days of pregnancy the spine (bone) should come together to cover the delicate spinal cord and surrounding tissues. A baby with spina bifida has an incomplete growth of the spine and is born with the spinal cord exposed, bulging out of the back. A baby with any type of spina bifida is at risk for serious problems including paralysis, infection and incontinence. Women who are trying to get pregnant should be eating foods naturally rich in folic acid and be taking a women’s multivitamin or prenatal vitamin that contains 800mcg of folic acid. If your multivitamin or prenatal vitamin contains that amount you should not need to supplement with an additional folic acid supplement.

Benefits of taking folic acid in the 1st trimester of pregnancy:

• Helps to prevent cleft palate
• Promotes proper development of the brain and skull
• Cuts neural tube defects by up to 80% (spina bifida)
• Important for red blood cell production
• Supports healthy homocysteine levels
• Supports proper cell division
• Supports healthy bone formation
• Helps prevent depression
• Together with vitamin B12, folic acid helps manufacture DNA and brain neurotransmitters

Folic Acid and High Homocysteine Levels

Three important B vitamins including folic acid, B6 and B12 help to break down the amino acid homocysteine in the blood; too much homocysteine may cause miscarriage due to the blood clotting more than it should. These three main vitamins can be used by the body to convert homocysteine amino acids into other products in the blood, to keep it from clotting unnecessarily. Women with a MTHFR Gene Mutations (especially the C677T variation) are much more likely to have higher than normal homocysteine levels in the body all of the time, but many cannot absorb or convert the folic acid in most supplements to methylfolate as it normally should. Women with MTHFR gene mutations should speak with their doctor about taking a specialized prenatal multivitamin that contains methylated versions of Folate and B12 known as Methylfolate and Methylcobalamin.

Cervical Dysplasia, Oral Contraceptives and Folic Acid Deficiency

Abnormal changes in the cells of the surface of the cervix is known as cervical dysplasia. Cervical dysplasia is generally regarded as precancerous and is determined by Pap smear. Many healthcare practitioners agree that many abnormal Pap smears reflect folic acid deficiency rather than true dysplasia, especially in pregnant women or women taking oral contraceptives. This is because estrogens antagonize folic acid.

Some researchers theorize that oral contraceptives may interfere with folate metabolism. Through testing, even though serum folate levels may be increased, folic acid levels within the cervical tissue may actually be deficient. Clinical observation and testing has shown that red cervical blood cell folate levels are typically decreased, while serum levels may be normal to increased in women diagnosed with cervical dysplasia. Oral contraceptives may stimulate the synthesis of a molecule that inhibits folic acid uptake by cells.

Clinical studies show folic acid supplementation of 10mg per day may improve and normalize Pap smear results in women diagnosed with mild to moderate cervical dysplasia. Research has shown that folic acid supplementation can prevent progression of cervical dysplasia even while still continuing oral contraceptives.

If you have been diagnosed with mild to moderate cervical dysplasia, talk to your doctor about supplementing with folic acid for 3 months before beginning treatment options, so that you can see if your next Pap smear comes back normal. Treatment options for cervical dysplasia are cone biopsy (abnormal cells of the cervix are removed), LEEP (loop electrosurgical excision procedure, electricity removes abnormal tissue), cryosurgery (freeze abnormal tissue), and laser removal of abnormal tissues. All of these procedures may damage the ducts which secrete cervical mucous. Lack of cervical mucous may make conception more difficult because sperm need cervical mucous to reach the ova (egg). I have personally worked with many women who have had these procedures and forever struggle to produce adequate amounts of cervical mucous afterward.

Foods Rich In Folic Acid

The name folic acid is derived from the Latin word folium, which means “foliage.” This is because many dark leafy greens have been found to be rich in folic acid. Many foods are rich in folic acid. When trying for a baby be sure your diet includes many foods rich in folic acid.

Important Note: Green and black tea has been shown to inhibit folic acid absorption. Avoid consuming more than 1-2 cups of green and black tea while trying to conceive and eliminate drinking it in early pregnancy.

Folic Acid Supplementation

Women of Childbearing age: 400mcg per day
Women Trying to Conceive: 800mcg per day
Pregnant and Lactating Women: 800mcg per day

Be sure that your multivitamin or prenatal vitamin contain vitamin B₁₂ as well. Folic acid should always be supplemented with vitamin B₁₂. Estrogens, chemotherapy and alcohol can interfere with folic acid absorption, so if any of those are of concern to you, speak with your doctor about how to ensure you are getting enough folic acid daily, especially if you are trying to conceive.

Both Fertilica Women’s Whole Food Daily Multi and Baby and Me Prenatal multivitamin contain 800mcg of folic acid/folate.

Can you take too much folic acid?
Some women worry that if they take other nutritional supplements that contain folic acid alongside their multivitamin, they will be taking too much folic acid. How much folic acid is too much? Well, studies using folic acid to treat cervical dysplasia have shown that high doses of folic acid at the upper limit of 5-10 milligrams, taken daily, is well tolerated by the body. To put this in perspective, most prenatal multivitamins contain 800 micrograms of folic acid. 1000 micrograms equals 1 milligram, so even if you combine a couple nutritional supplements that contain folic acid, you are still consuming far less than 5-10 milligrams.

References:
1. Murray, Michael T. N.D. (1996). Encyclopedia of Nutritional Supplements – The Essential Guide for Improving Your Health Naturally. New York, New York: Three Rivers Press.
2. Largeman-Roth, Frances RD. (2009). Feed the Belly – The Pregnant Mom’s Healthy Eating Guide. Naperville, Illinois: Sourcebooks, Inc.
3. Folic Acid. (n.d.) Retrieved online from: http://americanpregnancy.org/pregnancyhealth/folicacid.html
4. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002461/
5. Lynch, Ben. N.D. (Feb. 24, 2012). MTHFR C677T Mutation: Basic Protocol. Retrieved online from: http://mthfr.net/mthfr-c677t-mutation-basic-protocol/2012/02/24/