Give your baby a healthy start

You may not be planning on falling pregnant soon, but if you’re of child-bearing age it’s still worth knowing about folate, one of the B vitamins. In the US, over half of all pregnancies are unplanned, and as folate is needed both before and during the first weeks of pregnancy to help prevent birth defects, women planning pregnancy should ensure they are taking enough.

Folic acid is the synthetic form of folate, found naturally in foods such as citrus fruits, tomatoes, whole grain products, dried beans and peas, leafy dark green vegetables such as broccoli, brussels sprouts, and spinach, berries, liver and asparagus. Folate is important for the formation of red and white blood cells. A mild deficiency, which according to Samitivej Hospital nutritionist Dr Kumpol Sriwattanakul is quite common, can lead to anaemia, while in more severe cases it may lead to megaloblastic anaemia, a condition affecting the red blood cells.

Folate is required for DNA synthesis, and DNA itself allows cells to develop properly, including those in a foetus . If a woman is deficient in folate during the first 28 days of pregnancy, there is an increased likelihood that her baby will have a so-called neural tube birth defect, such as anencephaly or spina bifida. A baby with the former does not develop a brain, and will be stillborn or die soon after birth, while a baby with spina bifida will be born with a defect of the spinal column. Spina bifida manifests as a mild case of scoliosis, or more severely as paralysis and bladder or bowel incontinence. Around one third of spina bifida sufferers also have slight to severe mental retardation.

Bangkok Nursing Home Hospital obstetrician Dr Boonlert Triam-amornwooth says that it was debated for a long time whether or not folate deficiency could lead to neural tube defects, but the World Health Organsiation concluded four years ago that it could. "It now recommends that women preparing for pregnancy take about 400 microgrammes to one 1 mg of folate a day at least one month before pregnancy." Doctors usually recommend a 400 mcg daily intake to most people anyway.

Dr Boonlert says that taking a folate supplement with multivitamins before getting pregnant will also help reduce the risks of foetal abnormalities of other organ systems. "And it helps increase the chance of pregnancy too, by about six or seven per cent."

While it’s vital during the first days of pregnancy, the need for it continues for nine months, so obstetricians usually prescribe a folic acid supplement of around 800mcg per day. "Pregnant women definitely need extra folate because the total amount they get from food will not be adequate – no matter how good their appetite is."

Recent research has also shown that folic acid may help prevent heart disease by lowering the body’s levels of homocysteine, an amino acid thought to increase clot formation in the blood. High levels of homocysteine may also be linked to osteoporosis, strokes, and Alzheimer’s disease. But until clinical trials are completed, the jury is still out both on whether the amino acid is damaging and whether folate can truly help.

"Taking a folate supplement can have benefits in many ways and almost without toxicity at all," says Dr Boonlert. In fact, in January 1998 a US law was passed requiring foods such as flour, bread, rolls, corn grits, cornmeal, rice and noodle products to be fortified with 0.43 mg to 1.4 mg of folic acid per pound of product.

Nevertheless, once out of those childbearing years do not unnecessarily overdo your folate intake. A high intake might complicate the diagnosis of pernicious anaemia, which occurs commonly in older people due to a vitamin B12 deficiency. Extra folic acid can mask the symptoms of the condition, which may lead to permanent nerve damage if untreated.

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