Folic acid in pregnancy

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Folic acid and folate

Folic acid and folate: what they are

Folic acid and folate are B vitamins, also known as vitamin B9.
The word derives from the Latin folium, leaf.




Folic acid and folate: the difference

Folate and folic acid: These are often used interchangeably, but should not be confused.


  • folati: compounds naturally present in food,
  • folic acid (monopteroliglutamic or pterolimonoglutamic acid): the chemical synthesis molecule present in vitamin supplements and in fortified foods.

In addition to the chemical formula folate and folic acid, they differ in their different stability and bioavailability to absorption.
Folate must necessarily be introduced through food, as our body is unable to produce them, as the quantities produced by the intestinal bacterial flora are generally very scarce and cannot cover the needs.

The chemical structure

I folate from the chemical point of view they consist of a pterin ring, a molecule of p-aminobenzoic acid, and one or more glutamic acid residues.
In the molecule of folic acid, the pterin ring is in the completely oxidized form, while the folates present in food are reduced forms of the pterin ring (tetrahydrofolates) and can also have substitutions on the ring, thus giving rise to different forms: N5 methyltetrahydrofolate, N10 formyltetrahydrofolate and N5, N10 methylentetrahydrofolate.
Folic acid is the most stable form of folate and with greater bioavailability: once taken it is reduced to 5-methyltetrahydrofolate, which is the biologically active form of the vitamin.

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Women of childbearing potential who are planning to become pregnant should supplement their diet with folic acid. Proper nutrition allows you to cover your needs ...



In this article

Why folic acid and folate are important in pregnancy

Why is it important to take folic acid in pregnancy?

Scientific studies and efficacy trials conducted in several countries have shown that regular use of folic acid, started before conception, reduces the risk of developing severe congenital malformations such as Neural Tube Defects (NTD) with a risk reduction of up to 70 %. Supplementation also reduces the risk of developing other birth defects, such as congenital heart disease and cleft lip and palate, by 20%. To contribute to the reduction of the risk of these serious malformations, however, nutrition should not be neglected: observational studies have, in fact, shown that the populations following a Mediterranean-type diet, therefore rich in folate, assuming in particular a high percentage of vegetables and fruit, have a reduced incidence of DTN.



Balanced diet rich in foods rich in folate

All women who plan to become pregnant or who do not exclude the possibility must follow a balanced diet rich in fruit, vegetables and legumes. The advice is to consume at least every day

  • five portions of fruit and vegetables,
  • some whole grains,
  • two weekly portions of legumes
  • and occasionally dried fruit.

Folate deficiency

A deficiency in folate and folic acid can:

  • determine forms of anemia
  • increase the risk of severe fetal malformations, such as neural tube defects (including spina bifida, anencephaly and encephalocele) and other malformations, particularly some cardiovascular congenital defects, lip and palate malformations (cleft lip and palate), urinary tract defects and limb reduction.

According to the European surveillance of congenital anomalies (EUROCAT) there are, on average, 20 cases of congenital malformations per 1.000 births.

A diet rich in fruits, vegetables and legumes, containing folate, can help reduce the incidence of congenital malformations, but nutrition alone is not always sufficient to cover the daily requirement of folate and, if a pregnancy is planned, it is necessary supplement the diet with folic acid tablets.

A rich diet is not enough to cover the folate needs during pregnancy

Numerous studies have shown, in fact, that folic acid supplementation during pregnancy is effective in the primary prevention of neural tube defects, allowing a risk reduction of up to 70%.

Folic acid supplementation in pregnancy and earlier

Folic acid as soon as you start thinking about pregnancy and throughout the first trimester

All women planning to become pregnant or not applying contraceptive measures should take folic acid daily. Neural Tube Defects are malformations of the spinal cord due to the non-closure of the neural tube during the first month of intrauterine life; the neural tube closes between the 17th and 29th day of conception, when the woman has not yet ascertained her new pregnancy.

Special advice for women who have risk factors

4-5 mg of folic acid per day is recommended in women with risk factors for NTD and familiarity or previous pregnancy with NTD, positive family history of malformations, insulin-dependent diabetes, obesity, and epilepsy. Women of childbearing age who have one of these risk factors need to take the vitamin with particular care in the peri-conceptional period and should be monitored with particular care by health professionals.

How much folic acid to take

One 0,4 mg folic acid tablet every day

To be sure of ensuring the quantities of folic acid necessary for the reduction of Neural Tube Defects and other congenital pathologies, take one tablet of folic acid every day in the daily dose of 0,4 mg recommended for the prevention of congenital malformations. It is advisable to start taking it when you decide to have a child, as the neural tube closes between the 17th and 29th of conception, when the woman has not yet ascertained her pregnancy. It is important to remember that in Del Paese, folic acid at this dosage is listed on fully reimbursable drugs (class A). Therefore, the prescription on a red prescription from the attending physician is sufficient to purchase this supplement by paying only the ticket provided by your Region.

It is still important follow the quantities indicated, because an excess of vitamins (especially if you take multivitamin complexes together with a high consumption of fortified foods) could cause various types of damage, such as for example the masking of vitamin B12 deficiency. 

Read also: Folic acid: why it is important in pregnancy

Folic acid and breastfeeding

It is recommended for women duringbreastfeeding the intake of 0,5 mg / day of folic acid to replenish the lost quantities with breast milk.

Sources:

Iss; Epicenter; Minister of Health

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