Folic acid and pregnancy

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• What is folate or folic acid? 
• How can you increase your folate?
• Who should take folic acid tablets? 
• What is spina bifida?
• What is the risk of spina bifida? 
• Finding out whether an unborn baby has spina bifida

Taking folic acid before pregnancy and for the first three months of pregnancy can reduce your chances of having a baby with spina bifida. Spina bifida is where the spinal cord, and the bones, muscle and skin that cover it, do not form normally.

Research has shown that the chance of having a baby with spina bifida or similar problems (called neural tube defects) is much less if a woman increases her intake of folic acid for at least one month before she gets pregnant and for the first three months of her pregnancy. Every woman who could become pregnant should be sure she gets enough folate and this is best done by taking folic acid tablets.

Taking folic acid before pregnancy may also lower the risk of some other heart, kidney and limb abnormalities. The evidence for this is not as strong as for spina bifida, and more research is being done.

There is no evidence that other vitamins or minerals will protect your baby against spina bifida.

What is folate or folic acid?

Folic acid is a water-soluble B-group vitamin that is needed for healthy growth and development. The vitamin is known as 'folate' when it is found naturally in food, and 'folic acid' when it is added to foods or when it is in tablets. Folic acid is turned into folate in the body.  

It can be found naturally in most plant foods, especially green vegetables, wholegrain breads and cereals, peas and dried beans. 

Extra folic acid is also added to some foods, such as breakfast cereals. If folic acid is added, this will be marked on the labelling.

How can you increase your folic acid?

The easiest and most effective way is by taking a daily folic acid tablet. A healthy diet is important, but it is very difficult to get enough folate from foods to prevent spina bifida.

Folic acid tablets are quite safe to take. The tablets recommended are 0.5 milligrams (which is 500 micrograms). One tablet each day is enough.

Folic acid tablets are available from chemist shops (without a prescription), health food shops and some supermarkets.

Some multivitamins contain folic acid but often at a lower dose, so it is best to take the separate tablets.

Who should take folic acid tablets?

Folic acid works best if it is taken for at least one month before starting a pregnancy.

As many pregnancies are unplanned, it is recommended that all women of child-bearing age who could become pregnant take a folic acid tablet (0.5 milligrams) every day.

If you have a family history of spina bifida, or take medication for epilepsy, you may need a higher dose of folic acid. Ask your doctor about this.

Extra folate is not as effective if you start to take it after you know you are pregnant but it is worth taking it if you suspect you may be pregnant (for example, if you have missed a period).

The risk of having a baby with spina bifida if extra folic acid was not taken is still small.

What is spina bifida?

Spina bifida is a serious abnormality of the spinal cord, and the bones, muscles and skin covering it. Babies with spina bifida usually have an obvious abnormality on their back when they are born. Some will die soon after birth and most need a lot of treatment.

Spina bifida can cause permanently weak legs, no feeling in the legs and problems walking. Many people with spina bifida will need to use a wheelchair.

There can also be problems with bladder and bowel control.

Other neural tube defects affect the development of the brain as well as the spinal cord.

The problems occur when the spinal cord and brain are forming during the sixth week of pregnancy (four weeks after conception). This is often before a woman knows that she is pregnant.

There is no cure for spina bifida.

What is the risk of spina bifida?

Any woman could have a baby with spina bifida or other neural tube defect.

About 1 in 1000 babies in South Australia is born with spina bifida and another 1 in 1000 babies has another type of neural tube defect.

The risk is higher if another family member has had spina bifida. You can have tests to check for neural tube defects during pregnancy.

Finding out whether an unborn baby has spina bifida

Most women in Australia have an ultrasound examination during early to mid pregnancy. Most babies with spina bifida will be found by that ultrasound.

Blood tests which find most neural tube defects may also be done. 

Putting folic acid into foods

In the USA and Canada there has been mandatory (enforced) addition of folic acid to flour since 1998. That has successfully reduced the risk of spina bifida without any other health risks.

Regulations insisting that folic acid be added to flour or to bread will come into force in Australia soon.

For more information about folate in pregnancy talk to your family doctor, obstetrician, community health nurse or a dietician.

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