In this regard, however, the question of optimal FA dose for beneficial effects is somewhat unclear. The presence of plasma unmetabolized FA is reported to arise from higher dose FA supplements in pregnant and non-pregnant women [ 45 ]; however, it remains to be established whether there are any associated adverse metabolic or clinical impacts.
Therefore, the effects of exposure to high-dose FA in pregnancy on outcomes in the offspring are unclear and require further investigation.
In the meantime, given the uncertainty regarding long-term effects of exposure to high-dose FA, it seems prudent to recommend doses no higher than those demonstrated here in later pregnancy, and for NTD prevention in early pregnancy, as being beneficial with no known harmful effect [ 46 , 47 ].
A number of factors contribute to the strength of this study. The study design involving the follow-up of children from participants in an RCT in pregnancy [ 22 ] enabled us to demonstrate a causative link between maternal FA supplementation and subsequent cognition in the child. Maternal and newborn responses to FA intervention were measured by RBC folate, which is unaffected by recent intake and widely considered to be the best biomarker of long-term folate status [ 48 ].
The use of internationally recognized tools to measure cognitive performance in children is also a strength and enables the results from this maternal intervention with folic acid to be placed in a wider public health context for consideration along with findings from other antenatal or child interventions in relation to cognition in children [ 49 , 50 ].
This study was however not without limitations, the most significant of which was the relatively small sample size. In addition, the sample may not be representative of children generally, in terms of ethnicity and socioeconomic status, and therefore, the results require confirmation in other populations. Future work in this area would be much enhanced by combining cognitive tests as used in the current study with non-invasive brain imaging or novel brain mapping techniques, as previously applied to study the effects of nutritional interventions in pregnancy on brain health outcomes in the child [ 51 , 52 ].
The results show that there are benefits for the child of continuing maternal use of FA throughout pregnancy, whereas current recommendations in most countries worldwide advise mothers to take FA supplements from before conceiving until the end of the 12th gestational week only. If confirmed by further randomized trials in pregnancy with follow-up in childhood, these findings could have important impacts in informing future policy and practice in relation to FA recommendations in pregnancy.
Data are available from the Research Governance of Ulster University UK for researchers who meet the criteria for access to confidential data. Please address requests to Mr. Biomarkers of nutrition for development—folate review.
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Rust J, Golombok S. Description of the UK study. Babies born with anencephaly cannot survive. Babies born with spina bifida or encephalocele may face multiple surgeries, paralysis, and long-term disability.
According to a review of studies , maternal folic acid supplementation significantly decreases the risk of congenital heart defects. These defects occur in 8 out of every 1, births in the United States. They may impact the interior walls of the heart, the heart valves, or the arteries and veins of the heart.
Research also shows folic acid supplementation in early pregnancy may help prevent cleft lip and cleft palate. These birth defects occur if parts of the mouth and lip do not merge together properly during the first 6 to 10 weeks of pregnancy.
One or more surgeries are usually needed to correct the condition. All pregnant women should take get at least micrograms mcg of folic acid daily, according to The American College of Obstetricians and Gynecologists. Most prenatal vitamins contain this amount of folic acid. To make sure you have enough folic acid in your body to prevent neural tube defects, the CDC recommends women who plan to become pregnant or who are of childbearing age take mcg of folic acid daily. Your doctor can advise you on the right dose.
Natural folate is found in many foods including leafy greens, beets, and broccoli. Some foods in the United States are fortified with folic acid. These include:. Many servings of fortified breakfast cereals contain percent of the folic acid you need. If you have morning sickness in early pregnancy, it may be difficult to eat enough fortified foods to get the folic acid you need.
To make sure you get enough folic acid, doctors will usually recommend taking a folic acid supplement or a prenatal vitamin that contains folic acid before and during pregnancy. However, you should not consume more than 1, mcg 1 mg of folic acid from vitamins, fortified foods, or a combination of both daily. Folate is water-soluble and is easily destroyed by cooking. Folic acid is vital for healthy bodily growth and development in everyone and is especially important for pregnant women.
Your body uses folic acid to make DNA. The neural tube is one of the first things your baby will grow. The neural tube is formed in the first four to six weeks of pregnancy.
This can cause a range of disabilities including loss of bladder and bowel control, and paralysis of the legs. In some cases, the effects can be more severe. It is unclear what causes spina bifida but it can be linked to a combination of genetic and environmental risk factors, for example a family history of neural tube defects and folate deficiency.
Signs and symptoms of spina bifida vary by type and severity and can also differ per person. The best way to reduce the risk of your baby developing a neural tube defect is to take daily folic acid supplements from 12 weeks before conception until at least 12 weeks of pregnancy.
Adding a folic acid supplement to your diet when pregnant reduces the risk of your baby being born with a neural tube defect. You should take a supplement with micrograms of folic acid per day from 12 weeks before you become pregnant through to the first 12 weeks of pregnancy. Folic acid supplements are available over the counter from pharmacies at varying doses. Look for supplements that contain at least micrograms of folic acid. Multi-vitamin supplements generally contain less.
It is also important to eat healthy foods that contain folate including green leafy vegetables, broccoli, oranges, avocado, or fortified breads and cereals.
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