Get Primed for Pregnancy with Extra Folic Acid
Between two and four of every 1,000 babies born in Canada have neural tube defects that impact the spine or brain – these include spina bifida and anencephaly. A neural tube defect is where the spine or base of the brain does not form properly.
Before you get pregnant
The key is taking folic acid early enough to make a difference. As the baby’s neural tube development happens in the first six weeks of gestation, when most women don’t realize they are pregnant, a pre-conception folic acid supplement is ideal. However, the multi-vitamins that many people already include in their morning routine do not contain enough folic acid, and it’s difficult to get the recommended dose by diet alone.As a busy maternity care provider, Buhler offers some practical advice about getting the folic acid that you need. First of all, if you want to get pregnant, it’s important to note Canada’s Centre for Disease Control and Prevention now recommends thinking about pregnancy planning and visiting your doctor before you get pregnant.
“I don’t see enough women who do that yet,” Buhler says. “Women may not know that there are things that can be done to improve their health before they get pregnant: One of them is taking folic acid.”Your family doctor will also know if you are at increased risk of giving birth to a baby with a neural tube defect because of family history or existing health circumstances that may cause a folic acid deficiency. For example, obesity, smoking, digestive problems or certain medications can impact the body’s ability to absorb folic acid.
BC’s Maternity Care Pathway, which provides maternity care providers with recommendations for routine care during pregnancy, advises that most women benefit from a folic acid supplement containing 0.4 to 1 mg daily, but women considered to be at greater risk should take 5 mgs a day.
Hints for taking folic acid
As an experienced maternity care physician, Buhler advises her patients to take daily supplements containing at least one mg of folic acid. She also has some helpful tips for women who find it difficult to get the daily dose.
“Folic acid can stay in your body for several days to weeks, so for anyone who finds it hard to take their vitamin every single day, even one 5-mg tablet of folic acid a week is beneficial,” she says.“Most women are nauseated in the first three months of pregnancy. Since it is the iron in the multivitamin that aggravates nausea, I often recommend that they can try taking folic acid by itself.”
In her practice, she also reassures women who are already pregnant and worried about the lost opportunity to take folic acid pre-conception.“Start taking folic acid as soon as you find out that you are pregnant. This also has benefit. The chance of having a baby with a neural tube defect is relatively small, so focus on having a healthy pregnancy.”
Women who may benefit from higher doses of folic acid (5 mg daily) in pregnancy are:
• A higher risk of neural tube defects due to genetic or family history
• Digestive disorders that can affect absorption of nutrients, such as inflammatory bowel disease
• Obesity (with a Body Mass Index or BMI higher than 35)
• Difficulty taking supplements regularly
• Take anti-epileptic drugs
• Take folate antagonists (drugs that impact how folic acid works) such as methotrexate or sulphonamides
• Smoke tobacco
• Belong to higher risk ethnic groups, e.g. Sikh, Celtic, Northern Chinese
(The source for the above information about women who may benefit from higher doses of folic acid is an article from the Motherisk Program at the Hospital for Sick Children published in the Canadian Family Physician, April 2012.)
• The Motherisk Website - a Canadian resource with useful information for pregnant women.
• The Perinatal Services Maternity Care Pathway (for care providers) and Women’s Health Pregnancy Passport (for women)
• The U.S. Centers for Disease Control: Show Your Love: Steps to a Healthier Me and Baby to Be
• Dietitians of Canada online tool for calculating your Body Mass Index (BMI)
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