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Family Health Magazine
CHILDBIRTH

Folic Acid
It helps prevent neural tube defects

Most pregnancies end with the birth of a healthy baby. However, about three of every 100 babies born alive will have a birth defect. One of these, neural tube defect, or NTD may be preventable.

What is NTD?

The neural tube is made up of many cells that eventually form the spinal cord and brain. If the growth does not proceed properly, the result is NTD. The most common of these are spina bifida and anencephaly. In spina bifida, the bony spinal column does not form completely and the membranes of the spinal cord protrude through the resulting space. In anencephaly the skull and brain do not develop. Neural tube defects occur in two to four of every 1,000 babies born alive in Canada.

How can NTD be prevented?

Research shows that a woman who takes folic acid supplements before and during pregnancy may reduce the risk of having a baby with NTD. Taking the supplements before conception is important because neural tube defects occur 25 to 29 days after the egg is fertilized. At this point, a woman may not even realize she is pregnant. The best way a woman can guarantee that she will be taking a folic acid supplement during the critical days of cord development is to start taking it when birth control is not being used all the time.

What is folic acid and how is it taken?

Folic acid (also called folate or folacin) is one of the Vitamin B group. Foods rich in folic acid include grains, green vegetables (spinach and broccoli), meat (liver) and legumes (lentils and kidney beans).

Since a pregnant woman is unlikely to get enough folic acid from diet alone, folic acid supplements should be used. The amount of the supplement a woman needs should be discussed with her doctor. Most healthy women need a daily supplement of 0.4 mg (400 micrograms). Women who have diabetes or epilepsy, or have a close relative with NTD, or have had a previous baby, either live or stillborn, with NTD should use 1 to 5 mg daily.

A woman’s need for folic acid increases during pregnancy and breast feeding. For this reason many women are advised to continue using folic acid supplements throughout pregnancy even though the crucial development of the brain and spinal cord is complete.

Can tests detect NTD?

Tests are available that detect NTD in the second trimester (second three months) of pregnancy. One is a blood test (usually done between 16 and 18 weeks of pregnancy) that measures the level of a diagnostic protein called alpha fetoprotein (AFP) in the mother’s blood. The AFP level can also be tested in the amniotic fluid if amniocentesis is being done.

Another test is an ultrasound examination looking closely at the baby’s head and spine. This is usually done between 17 and 20 weeks of pregnancy. These tests are not harmful to the baby and will detect most babies with NTD. The decision whether or not to have them should be discussed with a doctor.

Why take the chance?

If a simple measure like using folic acid supplements can prevent NTD, does it make sense not to use them? Talk to your doctor about using folic acid supplements before you become pregnant.