Folate/folic acid is often talked about in relation to preventing neural tube birth defects (such as spina bifida) in pregnancy. Most women don’t think about taking a supplement before they’re pregnant, but folate/folic acid intake is important weeks before you’re pregnant. Read below to find out about neural tube development, what foods are high in folate and a comparison on different types of folic acid supplements.
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What is a neural tube and neural tube defect?
The neural tube eventually becomes a baby’s brain and spinal cord and the bones that enclose them. A neural tube defects occurs if the neural tube (brain, spine or spinal cord) doesn’t form properly. This can cause physical disability in a baby.
How can neural tube defects be prevented?
Neural tube defects can be prevented by increasing folate/folic acid intake before pregnancy and during early pregnancy. This can be done by eating more folate-rich foods or taking a folic acid supplement.
Folate is the natural form that’s found in food. Folic acid is the man-made (synthetic) form of folate, i.e. when it has been added to food (e.g. in bread) or in a supplement.
Let’s first talk about high folate foods which include:
- green leafy vegetables (e.g. spinach, cabbage)
- other green vegetables (e.g. broccoli, lettuce, asparagus, avocado, brussel sprouts)
- citrus fruits (e.g. oranges)
- organ meats (e.g. liver, kidney)
- legumes (e.g. chickpeas, beans, lentils)
- yeast extracts (e.g. Vegemite)
- fortified bread and cereal (have added folate).
Specifically, fortified breads and cereals have an interesting history here in Australia. To reduce the incidence of neural tube birth defects, it became compulsary in 2009 for folic acid to be added to wheat flour for bread making (known as fortification). Note this rule doesn’t apply to organic bread or bakery processes. Since this policy was introduced, there has been a reduction in the rate of neural tube birth defects in Australia. Cereals and fruit juices are commonly fortified with folic acid too. Companies usually add the words ‘high in folate’ on food labels of fortified products.
Unfortunately, folate easily breaks down when exposed to light, heat and air, and during cooking, so there may be little folate you eventually absorb from foods. This is why it can be difficult to get the recommended levels of folate from foods alone.
Given the importance of folate/folic acid in preventing neural tube defects and that most women aren’t able to get the recommended folate/folic acid levels from food alone, daily folic acid supplementation is widely recommended in addition to eating folate-rich foods. Folic acid supplementation can reduce the risk of developing a neural tube defect by up to 70%.
Why should I take a folic acid supplement before I’m pregnant?
A baby’s neural tube forms and closes in the first 4-6 weeks of pregnancy, often before most women are aware they’re pregnant. This is why folic acid supplementation is recommended for women before they fall pregnant, a crucial time for a developing foetus to benefit from extra folate/folic acid.
In fact, many health professionals and guidelines recommend that all women of child-bearing age (between 18-44 years old) who could become pregnant should take a folic acid supplement, even if not planning a pregnancy because about 50% of all pregnancies are unplanned.
A folic acid supplement of at least 0.4mg (or 400mcg) is recommended 1 month before getting pregnant (conceiving) and continued for the first 12 weeks of pregnancy (i.e. 3 months or first trimester).
What folic acid supplements are available?
Folic acid is also a core ingredient in pre-pregnancy or pregnancy multivitamins, however the dose may be low. If you take a multivitamin or other supplement, don’t start taking a folic acid supplement without first checking with your doctor or pharmacist.
Below are a few brands that contain folic acid only. You can buy these over-the-counter without a prescription at a pharmacy.
There isn’t really one ‘best’ brand – choose based on the price or whether the brand contains certain other ingredients (e.g. sugar, animal-derived products etc).
Megafol is the best value for money and some pharmacies sell a 0.5mg bottle for less than $4. You may need to ask the pharmacy staff for this brand as it may be kept behind the counter (although it doesn’t need a prescription). Sometimes I’ve found it in the iron supplements section.
One thing to note about the Blackmores Folate brand is that it actually contains folic acid, the synthetic form of folate. There are other forms of folate-related supplements that are available from naturopaths or other practitioners, but I haven’t had any experience with these.
You may need a higher dose of folic acid (5mg) if you’re at greater risk of a neural tube defect. Speak with your doctor, obstetrician or midwife if you’re unsure or if you’ve previously had a baby with a neural tube defect. Megafol is the only brand I’m aware of that has 5mg folic acid.