Opinion: folic acid consumption prior to pregnancy reduces the risk of having a neural tube defect pregnancy by around 70%
Folate is a B vitamin found naturally in a very wide range of foods such as oranges, nuts, meats, green leafy vegetables and legumes. It is important for cell division and red blood cell maturation. As folate in its natural form is not very bioavailable, the synthetic form of the vitamin, namely folic acid in the form of supplements or added to foodstuffs, is recommended prior to pregnancy.
By now, most of us know that it is important to take folic acid for around three months before becoming pregnant, but most of us do not listen to this advice or even know why it is important. The reason why folic acid is so important prior to pregnancy is because the template called the neural tube which goes on to form the brain and spinal cord is fully formed around 21 days after conception (fertilisation of the egg by the sperm). This is around the time when a woman might begin to suspect that she is pregnant, but it usually takes another few weeks before a woman takes a pregnancy test. By this stage, it is too late to take folic acid preventively as the neural tube has either closed or not.
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From RTÉ Radio 1's Today With Sean O'Rourke show, Louise Reynolds, dietician with the Irish Nutrition and Dietetic Institute, on the importance of folic acid
If the neural tube do not close properly, a number of conditions can occur at this stage. These are collectively called neural tube defects, such as spina bifida, anencephaly and encephalocele, and the severity of the defect can range from mild to severe. In mild cases, the infant can be born with only limited defects and can lead a healthy life. In moderate cases, the infant will have varying degrees of defect including paralysis of the lower limbs and organs and can suffer bladder and bowel incontinence, may need surgery in early life and ongoing surgery as he/she grows into adulthood.
In severe cases the infant can be born with only a partial brain or no brain at all. These are often referred to as fatal foetal abnormalities. These conditions have a genetic component and if you have a baby with a neural tube defect, there is an increased risk of having a subsequent affected pregnancy.
Folic acid consumption prior to pregnancy reduces the risk of having a neural tube defect pregnancy by around 70%. The recommendation is to consume 400µg of folic acid daily for at least three months prior to pregnancy and up to 12 weeks of pregnancy. If you already have had a child with a neural tube defect then you need to consume a higher dose of folic acid (4mg daily) that other mums to be.
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From RTÉ Radio 1's Morning Ireland, Michael Turner from the UCD Centre for Human Reproduction on calls for a public awareness campaign on the importance of folic acid in preventing neural tube defects during pregnancy
Ireland has one of the highest incidences of neural tube defect affected pregnancies worldwide and the most recent reports on prevalence in Ireland demonstrate that rates have risen in recent years. Globally, defects occur at a rate of approximately one in 1,000 births and twice as many babies with spina bifida are born in Ireland compared with the rest of the EU.
In reality, not very many women plan their pregnancies so most women do not take folic acid prior to pregnancy. The reasons for not consuming a supplement prior to pregnancy are many and varied and include apathy, perceived risk being low, or not planning to become pregnant.
If you are not planning to have a baby why would you take folic acid? Well, here is why: Irish women have higher rates of neural tube defects than other ethnicities. There used to be lots of folic acid added to the food chain in Ireland, like breads, spreads, yoghurts and cereals. Even though most women didn't know it, or ever thought about it, they were getting folic acid passively in their diets.
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From RTÉ Radio 1's Drivetime, Mary Rose Sweeney from DCU on the decline of folic acid in food
But this passive fortification led by the food industry has now declined and mums-to-be who did not know that they were being protected in the first instance, don't know now that they are not being protected. A recent report on pregnant women in Ireland found that one-third of women in early pregnancy in the study had folate levels lower than that recommended to prevent neural tube defects.
If you can’t be bothered to, aren’t organised or motivated enough to take a folic acid supplement, perhaps you need to start paying more attention to your diet. Very few food staples contain folic acid, but if they do, it will be listed on the food label. Read your labels carefully, choose your produce wisely – breads, yogurts, spreads, cereals, milks can all be passive suppliers of folic acid – you just need to choose the correct ones. Otherwise, the personal, societal and economic toll might be very high.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
