The Importance of Folic Acid in the Prevention of Neural Tube Defects in Pregnancy

Published 14th September 2020 | Dr Ujwala Parashar

Folic acid is a pregnancy superhero! It is never too early to start on folic acid supplements if you are planning on conceiving or even if you are not planning but are of childbearing-age.

Folic acid is a B group vitamin. We all need folic acid in our diet, but it is even more important for women wishing to become pregnant, during pregnancy and whilst breastfeeding to have consistent levels to assist in the prevention of a baby developing a neural tube defect.

Approximately one in 1,000 babies in Australia is born with a neural tube defect. There is not a cure for neural tube defects and the loss of function and nerve damage at birth is usually permanent, although there are some treatments available that can help prevent further damage and assist in the management of complications. The best option is positive steps towards prevention.

What are Neural Tube Defects?

Neural tube defects are serious birth defects that occur in the first month of pregnancy (often before a woman knows she is pregnant) and affect the development of the brain, spine, and spinal cord.

The most common types of neural tube defects are Spina Bifida, Encephalocele and Anencephaly.

What is Spina Bifida?

Spina Bifida is Latin for “split spine” - an abnormal development of part of the spine and the spinal cord. 

During the first month of life, the embryo (developing baby) grows a tissue structure called a neural tube. As the embryo grows, the neural tube changes into a complex structure of bones, tissues and nerves that eventually form into the spine and the nervous system. In the case of spina bifida, something occurs which impacts on the normal development of the neural tube so the spinal column does not fully close; is left exposed and can be easily damaged.

In severe cases, the skin, muscle, and the vertebral bones that protect the spinal cord nerves can all be missing.

What are the ongoing impacts of Spina Bifida?

A child with spina bifida can have the following ongoing health issues:

·       Some paralysis of the legs

·       Difficulty walking

·       Muscle weakness and loss of feeling in affected areas

·       Fluid pressure on the brain

·       Lack control of their bladder and bowel

·       Difficulties with learning, attention, and memory

What is Encephalocele?

Encephalocele occurs when the skull does not properly form to protect the brain. When this happens, part of the brain may “bulge out” due to the top of neural tube not being formed properly.

What are the ongoing impacts of Encephalocele?

Babies born with severe encephalocele often don’t survive beyond the first day of life.

With mild forms of encephalocele, children might have:

·       Intellectual disability

·       Cerebral palsy

·       Seizures

·       Other difficulties

What is Anencephaly?

Anencephaly is a serious neural tube defect that occurs when part of the brain doesn’t develop. Babies with anencephaly are usually stillborn or die shortly after birth.

How can Folic Acid assist and why is it important during pregnancy?

Folic acid is a man-made version of folate which occurs in B Vitamins and plays an important role in the body’s production of red blood cells. When taken before and during early pregnancy, folic acid aids in a baby’s neural tube development including the nervous system, brain and spinal cord and has been proven to assist in the prevention of neural tube defects.

When is it best to commence taking Folic acid supplements; how much, and for how long?

Neural tube defects occur in the first 3-4 weeks of pregnancy, so if you are planning on falling pregnant, you should start taking Folic acid at least one month before conception (although it’s never too early to start if you are a woman of child-bearing age) and continue to take supplements every day during pregnancy and whilst breastfeeding. 

There are some pre-natal vitamins that include folic acid, but it is important to check that they have the correct dosage. The recommended dosage of folic acid supplements from one month prior to conception to the first three months of pregnancy, from month four to month nine of pregnancy and during breastfeeding ranges from 0.4mg – 0.8mg. 

Are there natural forms of folate?

Folate occurs naturally in a wide variety of foods including vegetables (dark green leafy vegetables such as kale and silver beet) citrus fruits, fruit juices, avocado, nuts, grains, legumes, seafood, eggs, and dairy. Some of the highest folate levels are found in spinach, asparagus and brussels sprouts, but note that folate is water soluble and is easily destroyed in the cooking process. The best methods for cooking and retaining folate in food is steaming and microwave.

Folate becomes folic acid when added to foods and is present in fortified foods such as pastas, rice, and some breads and breakfast cereals.

Although it is great to include these foods in your diet for the naturally occurring folate, it is virtually impossible to ensure the right amount of levels of folic acid required without supplements.

When are higher doses of folic acid required?

There are some women who have an increased risk of a pregnancy affected by a neural tube defect, and in these instances, a higher dose of folic acid is advised from pre-conception up until 3 months pregnancy.

Women with an increased risk of neural tube defects in pregnancy include:

·       She or her partner have a neural tube defect

·       She or her partner have a family history of neural tube defects

·       She has had a previous pregnancy with a neural tube defect

·       She is diabetic

·       Obesity

·       She takes anti-epileptic medication

If you have/had any of the above circumstances, Dr Parashar may recommend some additional tests for you prior to conception.

The take home message

Folic acid is a pregnancy superhero! It is never too early to start on folic acid supplements if you are planning on conceiving or even if you are not planning but are of childbearing-age. 

Be safe. Plan ahead.

Dr Ujwala Parashar, Obstetrician & Gynaecologist

Sam Samant

Dr Ujwala Parashar is a highly trained female obstetrician and gynaecologist with over 15 years of professional experience and training, practicing in Sydney's North Shore and Barangaroo. If you would like more information on conception, or if you are seeking obstetric options and advice, please contact us or call 1300 811 827 to arrange a consultation with her.