The US Preventive Services Task Force has just published an update to its 2009 recommendation for folic acid supplementation in the Journal of the American Medical Association (JAMA). The latest recommendation confirms that women who are capable of or planning pregnancy should take a daily supplement containing 400 to 800 micrograms of folic acid since it can reduce the risk of certain spine and brain defects, particularly neural tube defects (NTDs). These birth defects occur very early in pregnancy often before a woman knows that she is pregnant, the task force explained.
Neural tube defects (NTDs) are abnormalities that may develop very early in the formation of the embryo, as soon as the neural tube is formed. (The neural tube normally becomes the spinal cord, spinal column, and brain of the baby.)
“Most women in the United States are not consuming fortified foods in a quantity needed to demonstrate optimal benefit,” said the report by the USPSTF, an independent, volunteer panel of experts.”
Folic acid, also known as folate or vitamin B9, is a naturally occurring version of vitamin B9 that is found in dark, leafy green asparagus, broccoli, citrus fruits, beef liver and beans. Folic acid aids the body in producing and maintain new cells, as well as being involved with DNA repair. An adequate folic acid during pregnancy is critical since cells are growing and dividing very quickly, as the placenta develops and the fetus is growing.
According to the Centers for Disease Control and Prevention (CDC) birth defects affect approximately three percent of babies born each year in the United States, and they are the leading cause of death among infants.
There have been significant previous studies going back decades that support folic acid supplementation in women of childbearing age. In 1991, a study found that folic acid supplementation greatly reduced the risk of neural tube defects, a type of birth defect that includes anencephaly, where the baby is born without a brain or skull, and spina bifida, where there is incomplete closing of the backbone and membranes around the spinal cord. About 1,200 US pregnancies are affected by anencephaly and 1,500 babies are born with spina bifida each year.
"Since neural tube defects occur in the first few weeks of pregnancy, it is important for women to be taking the recommended amount of folic acid before they become pregnant," wrote Laura Mitchell, professor at the University of Texas Health Science Center at Houston School of Public Health.
"Because approximately one-half of pregnancies in the United States are unplanned, the USPSTF recommendation holds for all reproductive-age women, whether or not they are planning a pregnancy, so that all pregnancies benefit from this preventive measure," Mitchell said.
The American College of Obstetricians and Gynecologists, American Academy of Family Physicians and the Centers for Disease Control and Prevention (CDC) also recommend that pregnant women take at least 400 micrograms of folic acid daily.
"These supplements can be taken as a daily multivitamin, prenatal vitamin or single tablet that has the recommended amount of folic acid," said Alex Kemper, MD, in the task force news release. Dr. Kemper is a professor of pediatrics at Duke University Medical School, in Durham, North Carolina.
The key for preventing NTDs is for women to start taking the folic acid at the right time. The CDC recommends that all women between 15 and 45 years of age should consume folic acid daily since half of U.S. pregnancies are unplanned and since these birth defects occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant. Again, women can get folic acid from fortified foods or supplements, or a combination of the two, in addition to a varied diet rich in folate.
In addition to taking making sure to take a folic acid supplement, pregnant women can reduce the risk of birth defects can be reduced by avoiding cigarettes and alcohol as well as other harmful substances. Maintaining a healthy lifestyle that includes a nutritious diet and exercise is recommended.
The CDC also recommends that women seeking pregnancy should practice “preconception health care”. That is, the medical care a woman or man receives from the doctor or other health professionals that focuses on the parts of health that have been shown to increase the chance of having a healthy baby.
Sources:
- http://jamanetwork.com/journals/jama/fullarticle/2596300
- http://www.thelancet.com/journals/lancet/article/PII0140-6736(91)90133-A/abstract
- https://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm
- https://sciencebasedmedicine.org/the-benefits-and-risks-of-folic-acid-supplementation/
- https://www.cdc.gov/ncbddd/birthdefects/prevention.html