A few weeks ago, January 7-13, 2008, was National Folic Acid Awareness Week at the Centers for Disease Control (CDC), therefore we wanted to take the opportunity to remind women of the importance of folic acid in the prevention of birth defects. Folic acid can prevent from 50-70% of neural tube defects, which are defects of the spine (spina bifida) or the skull (anencephaly). Spina bifida is the leading cause of childhood paralysis and anencephaly is nearly always fatal.
Folic acid is a B-vitamin needed for proper cell growth and can be found in many multi-vitamins as well as many food sources. Since 1998, The Food and Drug Administration has required the addition of folic acid to many enriched breads and cereals in order to increase the synthetic folic acid in our diets.
The CDC, the U.S. Public Health Service and the American College of Obstetricians and Gynecologists (ACOG), urge every woman who could become pregnant to get 400 micrograms (400 mcg) or 0.4 milligrams of synthetic folic acid every day. Most multivitamins contain 400 micrograms or 0.4 milligrams of folic acid. Most prenatal vitamins have approximately 800 micrograms or 0.8 milligrams of folic acid.
By taking the recommended dosage of folic acid daily, women will reduce the risk of neural tube defects as described above It is important for all women of child-bearing age to take this recommended daily dosage of folic acid even if they are not planning pregnancy because folic acid is needed in the first weeks of pregnancy, even before a woman may know she’s pregnant. Because a high percentage of all pregnancies are unplanned, any woman who could potentially become pregnant should take folic acid daily.
Once a woman is pregnant, she should continue to take at least 400 micrograms or 0.4 milligrams of folic acid during the first 3 months of pregnancy. If a woman has a history of having a child with neural tube defect, she is at increased risk of having another child with a similar defect. It is recommended that these women should take a higher dose of folic acid (4 milligrams or 4000 micrograms) daily. Women with a family history of neural tube defects are also advised to take an increased dose of folic acid. Women who take certain medications, like mood stabilizers or antiepileptic drugs, are also advised to take increased doses of folic acid while planning pregnancy and throughout pregnancy.
Women are advised to discuss all their medications with their OB/GYN to determine if they should be taking an increased dose of daily folic acid. If your health professional recommends you take an increased dosage of folic acid, be sure to take it in the form of folic acid tablets rather than taking more multivitamins in order to get the increased dose of folic acid. Taking more than the recommended number of once-daily multivitamins could potentially result in higher than recommended doses of the other vitamins contained in the preparation.
April Hirschberg, MD