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May 5th, 2008
10:43 AM ET

Dishing on folic acid

By Jennifer Pifer
CNN Medical Senior Producer

I am getting married in October.  Since my fiancé and I got engaged, most of our free time has been spent planning the wedding, selling our individual homes and looking for a new home to buy together. Getting married in your 30s seems much more complicated than getting married in your 20s. There are lots of balls to juggle.  Just when I think I'm getting into a rhythm, something else comes up.

Take what happened a few weeks ago.

My future in-laws were over helping us get my fiancé's house ready to put on the market.
My future mother-in-law and I were in the kitchen organizing the cabinets.

"Now I know it's none of my business," she said as she deftly sorted orphan silverware and mismatched mugs, "but if you are thinking about starting a family in the next year, you need to start taking folic acid."

I haven’t even found a wedding dress. Now I have to start planning for a baby?

Turns out, my betrothed's very wise mother is right. Doctors have known for years that women who take folic acid before they get pregnant cut down the risk of serious birth defects such as spina bifida. Now new research suggests women who take folic acid supplements for a least a year before they become pregnant can slash their risk of having a premature baby by half. That, in turn, can lower the risk of things like cerebral palsy, physical disabilities like blindness and mental retardation.

Intrigued and new to the world of all things prenatal, I called Dr. Radek Bukowski at the University of Texas Medical Branch. He's the doctor leading this research. "Folic acid has a lot of powerful effects," Dr. Bukowski says, but "nobody really knows why folic acid works." One of the leading theories, says Dr. Bukowski, is that if it is taken before conception and during the first few months afterwards "maybe it protects against infection."

Dr. Bukowski also told me the average woman, with no history of having children with birth defects, can get enough folic acid in a multivitamin. It seems like a simple step all women can take to increase the odds of having a health baby. Moms out there – what other things would you suggest? And what do you wish other moms had told you before you got pregnant?

As for me, I have some more research to do. Wonder if folic acid can help me lose 10 pounds in time for my wedding?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


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soundoff (33 Responses)
  1. Jim Swartzendruber

    Taking supplements is okaaay – but is a healthy diet with "something green" in most meals a better way? I'm not saying women need to religiously follow the food pyramid, but a meal should feel unsatisfying when a vegetable is missing.

    May 5, 2008 at 11:58 | Report abuse | Reply
  2. CRB

    If you're concerned about folic acid intake and absorption- beware green tea! The active ingredient, also promoted as a weight loss suppliment, EGCG can prevent folic acid absorption. It binds to and inhibits an enzyme called dihydrofolate reductase (DHFR) needed for our bodies to absorb the folate we eat. While you would have to drink a lot of green tea to have a negative impact, many suppliments now include EGCG and could pose a problem.

    May 5, 2008 at 13:36 | Report abuse | Reply
  3. Grace

    What foods supply folic acid? What dietary changes can one make to get the same amount of folic acid as from a supplement? What changes have happened to the human diet and food sources that we now need to take supplements and vitamins?

    May 5, 2008 at 19:27 | Report abuse | Reply
  4. Terry

    I had a daugter with spina bifida, she passed away this past November eighteen days before her 22nd birthday, the cause of death was simply stated as complications from spina bifida, although there were a whole host of medical issues that she had, the most recent was a diagnosis of lupus. In any event, I was always told by her physicians that spina bifida is a genetic birth defect, and that both parents contribute to it. I was also told much later on that folic acid can lessen the degree of severity, as the primary problem is lack of develop and subsequent closure of the spine, often occuring I believe in the third month or so of pregnancy. The point I am trying to get at is that when I was pregnant with my daughter, I worked a full time job and also had my son who was a little over a year old. I was not concientous about taking my prenatal vitamins and I often wonder whether or not that had some impact, although hers was not the most severe form of spina bifida, in that it occured very low on her spine. My suggestion is to be diligent about taking the prenatal vitamins and folic acid supplements as suggested by your physician. Maybe she would still be here today, if I had been more informed and knowledgable in 1984.

    May 6, 2008 at 17:00 | Report abuse | Reply
  5. kathy

    Okay so how much is enough? If your taking a prenatal vitamin, do you also need a suppliment and if so what dosage is required? I know you get some from your food, but can you get too much in your system?

    May 6, 2008 at 18:22 | Report abuse | Reply
  6. Madhuri

    Good to know the benefits of folic acid. Are there any side effects for taking excessive folic acid?

    May 7, 2008 at 09:44 | Report abuse | Reply
  7. Nicole

    I am so glad I stumbled upon your post. There is not nearly enough attention being paid to folic acid and the connection to spina bifida. I am now in a race to try and find someone to save my sister-in-law. She has spina bifida and is dying. She fell and hid this from her husband. She now will not live to the 21st of this month. She has an infection from a piece of broken bone in her pelvis. She only has a 3-5% chance of surviving a double amputation, but no hospital in California will accept her. I am desperately trying to find anyone with information on how to help save her life. There needs to be more focus on this issue-and living with spina bifida. She recently had her first visit to Wal-Mart, and was so excited because her mother did not take her anywhere. I want her to be able to experience much more than just Wal-Mart. Can anyone suggest anything?

    May 7, 2008 at 12:33 | Report abuse | Reply
  8. klg

    It is recommended that women in general take 400 micrograms of folic acid daily. When pregnant, or trying to become pregnant, the general recommendation is 800 micrograms. Folic acid is a water-solubale vitamin, so your body flushes out the excess if too much is consumed.

    May 7, 2008 at 13:29 | Report abuse | Reply
  9. Sassy Britches

    Just wanted to leave a little FYI that it is possible to have too much folic acid. After having some blood tests done recently, my doc told me to stop taking any supplements that have folic acid in them. Yes, that included my multivitamin. Do your research, talk to your doctor(s) and make sure you're doing what's best for YOUR body. Folic acid is necessary and generally not harmful but don't assume anything.

    May 7, 2008 at 15:18 | Report abuse | Reply
  10. Nutritionist

    To prevent neural tube defects such as spina bifida and anencephaly you have to have a supply of folic acid in your system before and during pregnancy. Especially in the first trimester because this is when the spine and brain/CNS is developing. Folic acid is a B vitamin and is water soluble, which means you don't store it in fat cells, so it is important to keep it in your system.
    Multivitamins should have 400 mcg of folate or folic acid in them. Also eating grains that are fortified with folic acid can keep levels up. Natural food sources are: black beans, blackeye peas, refired beans, pintos, split peas, chicken liver, beef liver, peanuts, sunflower seeds, spinach, turnip greens, broccoli, mustard greens, and OJ.

    May 7, 2008 at 16:07 | Report abuse | Reply
  11. Terry

    Nicole, contact your local spina bifida association, they will be able to give you information about physicians who specialize in this birth defect and they are a network of people with spina bifida and their families. Your sister-in-law is most likely not the only person that this has happened to, good luck.

    May 7, 2008 at 16:45 | Report abuse | Reply
  12. Freida

    Jennifer,

    I definitely agree with your in-laws! Taking folic acid prior to planning having a baby (especially if you are in your 30's. Thirty five years old and over is considered a risk factor), significnatly reduces neurological birth defects risks. The research on this topic is vast, and consistently indicates the benefits of its use in reducing your risks of having a child with NTD (Neural Tubal Defects, i.e. Spina Bifida). I am 32 years old, and also planning on getting married next year. My GYN doctor, firmily believes that I should start taking 2-4mg of folic acid daily, at least 3 months prior to conception. And continue throughout the entire pregnancy, but more importantly during the 1st trimester when the fetus's neurological system is developing. You may not need to start taking a year from now, but at least 3-6 months prior to conception. It is always a good idea to discuss this in more detail with your doctor. Good luck! 🙂

    Freida NYC

    May 7, 2008 at 18:51 | Report abuse | Reply
  13. Rose

    My husband is about to begin chemotherapy and his pre-medication includes 500 mg. folic acid daily. which we are told may be helpful in counteracting some side effects of the therapy

    May 7, 2008 at 20:08 | Report abuse | Reply
  14. Danielle

    I cannot even think about the number of times my dr has told me to be taking Folic Acid over the past few years. I'm 27 & have only been married a year. But he's been telling me since I was 24. I take birth control but he said even though I'm not planning on having a baby anytime soon, that I need to be taking it just in case I get a "pleasant surprise". Considering the health problems in my family as well as my husband's family, I'm definitely heeding his advice.

    May 7, 2008 at 21:10 | Report abuse | Reply
  15. Patricia, RN

    While it's important to have a healthy diet with plenty of fruit and vegetables, women who can get pregnant should get 400 micrograms (100% DV) of synthetic folic acid from vitamins or fortified breakfast cereals to prevent serious birth defects of the brain and spine. Food folate is a complex form of folic acid that must be broken down before it can be used. It is very difficult to get the amount of folic acid that women need every day from food. That's why experts urge all women who can get pregnant to get their daily requirement of folic acid from a vitamin or fortified breakfast cereal in addition to eating a healthy diet with plenty of fruit and vegetables.

    It's important for women to know that half of all pregnancies in the U.S. are not planned! Even women who are not thinking about having a baby but can get pregnant should take 400 micrograms folic acid every day. Most multivitamins in the U.S. contain 400 micrograms folic acid in one pill, and several breakfast cereals provide 400 micrograms (100% DV) in one serving.

    Folic Acid: All Women, Every Day!

    May 8, 2008 at 09:54 | Report abuse | Reply
  16. Molli

    Folic Acid is also useful in fighting off infections of the genital tract. I was on 1000 mg of folic acid for years as my body acclimated to being one of those people blessed with a variety of HPV.

    May 8, 2008 at 12:39 | Report abuse | Reply
  17. AC2007

    There is nothing more devastating to a mother to think that an NTD is in any way her "fault" for not doing something right. Sometimes it just happens, and it is NO ONE's fault. I think we owe it to women everywhere be honest and accurate here.

    I think it is misleading and inaccurate to imply that taking the recommended amount oFolic Acid is a "sure fire guarantee" against NTDs.

    The fact is, taking folic acid will NOT "prevent" NTDs 100% of the time any more than laying an infant on his/her back "prevents" SIDS 100% of the time. It will, however, greatly "reduce" one's chances of having this happen, which is something every woman should strive for... giving their pregnancy it's best chance.

    If you're doing everything you know to do with the information you've been given, then please understand that losing a pregnancy/child to a NTD is NOT YOUR FAULT. Sometimes it just happens...

    I've known at least two women in my lifetime (my sister, an MD, being one), who took everything they were supposed to for at least as long a they were supposed to, including 800mcg of folic acid daily, and still lost their pregnancies to NTDs.

    But they knew two things going in: 1. they did everything they knew to do with the information they had at the time, and 2. doing everything you know to do is no guarantee of a healthy baby as an outcome.

    May 9, 2008 at 11:01 | Report abuse | Reply
  18. quirkyrabbit

    Folic acid is an excellent aid at preventing spina bifida and even cleft palates as well as a host of other birth defects. Further, pre-pregnancy B6 should help prevent early pregnancy nausea.

    It has been known since the 70s that both these vitamins should be supplemented if you are taking birth control pills or HRT.

    Finally, the nun-study (and, I'll wager, other studies) show that women in that study who died suffering from dementia or alzheimers, had very low levels of folic acid. The elderly women who died with brains intact had high levels of folic acid!

    So, we find that folic acid is far more important to our health than doctors tell us.

    Yes, folic acid comes from green, leafy vegetables, but so much is gone from it by the time it gets to our tables. To be safe, I'll supplement wisely!

    I recommend you all do thorough Internet Searches on Folic Acid and B6 and pregnancy and dementia to draw your own conclusions.

    BTW, there were limitations put on folic acid capsule size years ago because apparently some Vegetarians or people with high folic acid, were unable to quickly notice they had pernicious anemia.

    Read up on folic acid! I'd provide links, but I know YOU are smart enough to find and research and follow information you can get on the internet.

    Nothing is 100%, but I sure wouldn't want to take a chance without it.

    May 10, 2008 at 09:32 | Report abuse | Reply
  19. Ratna, New York, NY

    Hi Jeniffer,

    The foods you should be eating the most now are: nuts and lentils, which are loaded with folic acid. And yeah! losing 10 pounds requires a reduction in calorie intake (in which these healthy folic acid rich foods are included, in moderation of course) and a steady exercise regime. And further, there are lots of other nutrients the body needs: http://www.mypyramid.gov

    May 12, 2008 at 18:48 | Report abuse | Reply
  20. katbur

    Talk to your OB/GYN, most are confident that the amount of folic acid in a prenatal vitamin is sufficient. I work in early childhood intervention, children under three years old. Our numbers of children with spina bifida and other neural tube defects have decreased substantially since the folic acid recommendations have been made.
    http://www.aftercancernowwhat.wordpress.com

    May 16, 2008 at 18:11 | Report abuse | Reply
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