Women's Health Week: Folic Acid & Women's Health

If you're trying to conceive, either on your own or with fertility treatment, it's a great idea to act as if you're already pregnant. 

A key element found in a good prenatal vitamin is folic acid. So in light of Women's Health Week, the experts at Reproductive Medicine Associates of Connecticut (RMACT) is putting a spotlight on this essential vitamin and why all women of childbearing age should be taking it daily.

Carolyn Gundell, MS, RMACT's Fertility Nutritionist has been working for decades to help her patients be as healthy as possible and have a healthy pregnancy, healthy baby and healthy family. She shares information and her recommendations about folic acid in today's post.

Folic Acid & Fertility: A Necessary Nutrient Before, During, and After Pregnancy

What is folic acid?

Folic acid is an essential B-vitamin and the synthetic form of naturally occurring folate found in foods. Folic acid is necessary for DNA synthesis of red blood cells, nervous system, and proteins and cellular growth and reproduction. This synthetic version can be found in multivitamins, prenatal vitamins, and folic acid fortified foods such as breakfast cereals, pasta, and bread.

Why is folic acid so important for a pregnancy?

Folic acid is a nutrient that is known to have a direct effect on preventing a type of birth defect called a neural tube birth defect. If folic acid / folate intake is deficient, neural tube birth defects are serious and can affect the fetal spine and brain at the time of conception and within the first 28 days of fetal development during which time the spine is forming. Spina bifida and anencephaly are examples of two more common neural tube defects.

Folic acid is also an important nutrient for healthy sperm. All men who are actively trying to conceive will benefit from a basic men's multivitamin containing 100% of the RDA, not a mega dose formula.

When is the best time to start taking folic acid?

All women of childbearing should be taking folic acid daily. It is best to start three months (90 days) or more before conception. Although many people will take a vitamin first thing in the morning or at breakfast, it's recommended to take vitamins with food at a larger meal, such as lunch or dinner.

Start by checking your prenatal vitamin—RMACT recommends a minimum intake of 800 mcg. folic acid (not folate) as a part of your prenatal regimen.

If a woman has already had a child with a neural tube defect, her risk for having another is very high. She should speak with her physician or OB/GYN to get a prescription for a higher dose of folic acid.

Could taking too much folic acid be a problem?

Yes. Do not take more folic acid than recommended by your physician or nutritionist. A mega dose of folic acid, without a medical reason, can mask a B12 deficiency, causing pernicious anemia and irreversible nerve damage.

Why not just eat food sources rich in folate instead of taking synthetic folic acid?

The naturally occurring folate in food sources is important too, but it is not wise to rely on food-based folate intake alone for the following reasons:

1. Food based “folate” has a forty percent lower absorption rate compared to folic acid. If folate, not folic acid, is listed on your supplement bottle then it is advised to switch to a supplement that lists folic acid instead of folate. Many prescription prenatal vitamins list methyl folate as the source of folic acid. 1000mcg. (or 1 mg.) methyl folate is a bioactive form of folate and is equivalent to 600mcg. folic acid—an acceptable minimum dose for a singleton pregnancy. Multiple pregnancies may require more folic acid in the first trimester and women should consult with the physician supervising their pregnancy.
2. Folate in foods is easily destroyed when foods are cooked or canned. Fifty percent of food folate is lost in the canning process and up to ninety percent can be destroyed in cooking. Lightly steaming food instead of boiling it in water is recommended.

What about foods that are fortified with folic acid?

Since folic acid fortification of US grains started in 1998, neural tube birth defects have decreased by thirty-five percent. However, even with this fortification, not all women are getting enough of this essential B-vitamin. Here are a few reasons why a woman’s food intake may not be enough and why a folic acid supplement is so important:

1. Folic acid /folate is a water-soluble nutrient, which means that our bodies do not store this B vitamin. Availability is dependent upon an individual’s daily nutrient intake.
2. The main food group that receives folic acid fortification is grains, which is a food group that is recommended in general for lifelong health. However, manufacturers of whole grain products are not required to fortify with folic acid—so be sure to check the labels for this indication.
3. Many women focus on organic foods when trying to conceive and during pregnancy. However, manufacturers of organic grains are also not required to fortify grain with folic acid. Some do, but many do not. It is recommended to check the labels of your favorite organic grain products for folic acid fortification.
4. Ethnic foods found in the US are often not fortified with folic acid. This is especially true for corn masa flour—which is more popular among Hispanics. In fact, Hispanic women are twenty percent more likely to have a child with a neural tube birth defect than a non-Hispanic white woman.
5. Some medications and regular intake of alcohol can interfere with folate metabolism and other medications can reduce the serum and tissue concentration of folate.

Should we still eat foods rich in folate?

Yes! And in addition to folate-fortified foods, the good news is that folate is found naturally in many foods. Excellent sources of folate include leafy, dark green vegetables, citrus fruits, lentils and beans, asparagus, peanuts and wheat germ. Remember, folate in foods is easily destroyed when foods are cooked or canned so when eating these foods, pay attention to their preparation to preserve folate. Incorporating these foods into a daily meal plan, in addition to taking supplemental folic acid from a prenatal vitamin, is essential and beneficial for conception, healthy baby and healthy pregnancy.

Carolyn Gundell, RMACT Nutritionist, is available to RMACT patients for all nutrition and lifestyle support during preconception and pregnancy as part of the RMACT Nutrition Program. If you are interested in an appointment with her, please contact your RMACT Navigator.