We all hope for healthy pregnancy outcomes – for all pregnant women everywhere in the world. The health status of pregnant women and newborn babies is an extremely important topic for all of society.
With this in mind, there are some common pregnancy-related complications which are worth learning about – mainly because such health complications are preventable.
In this post, we discuss the efficacy of using folic acid supplements to prevent pregnancy health complications.
If you are currently a pregnant woman, or if you are planning of becoming pregnant in the future, then it is probably useful for you to learn about the benefits of folic acid supplements. Yet, we are counting on all men as well everywhere to spread the message that nutrition is important for healthy pregnancies!
In this post, first we review evidence supporting the use of folic acid supplements during pregnancy. What have researchers learned about preventing health complications in developing fetuses? Do folic acid supplements support the healthy development of newborn children, during early childhood stages?
Next, we discuss the United States nationwide programs for fortifying food with folic acid. How do such programs improve pregnancy outcomes across the country? Are these programs efficient enough to cover pregnant women nutrition needs or is there need for Folic Acid supplements necessary too?
Last, we get practical and explore Folic Acid doses and timing for optimal effects. What are the latest guidelines on using folic acid supplements in your diet? Also, when is the right time to start taking Folic Acid supplements? Is it before or after you become pregnant?
Part 1: Folic Acid Prevents Pregnancy & Newborn Health Complications
Pregnancy-related health complications include potential issues with the health status of pregnant women, developing fetuses, and newborn babies who might experience post-birth health issues.
There is growing evidence that taking folic acid supplements during pregnancy is a good strategy for preventing health complications – both for pregnant women and their developing fetus.
In addition, folic acid supplements likely reduce the risk for certain types of health issues in newborn babies and even during early childhood stages.
Next, we review the most important benefits of using folic acid supplements during pregnancy.
1.1 Fetal Growth Restrictions
Folic acid has been shown to promote healthy fetus development during pregnancy [R1].
Growth restrictions in developing fetuses are one of the major types of pregnancy-related health complications. Among fetal growth restrictions, the most researched type are potential defects in the neural tube of developing fetuses.
The neural tube is extremely important during the embryo development phase. This is the embryonal structure from which the central nervous system (brain and spine) of the fetus is formed during pregnancy.
The year 1992 was the first time that conclusive evidence was published – in support of the efficacy of folic acid supplements for the prevention of neural tube defects. In this study featuring 5,453 women participants, scientists discovered that a daily intake of 0.8 mg (800 micrograms) folic acid supplement, resulted in much lower risk for neural tube defects in developing fetuses [R2].
According to relatively recent estimates, each year higher folic acid intake (food and supplements combined) prevents approximately 1,300 newborn babies from being affected by neural tube defects in the United States (based on 1995-2011 data) [R3].
1.2 High Blood Pressure During Pregnancy
The presence of excessively high blood pressure in pregnant women is another potentially serious health issue. This condition is known as pre-eclampsia – a condition that negatively impacts the overall health status of pregnant women. [R4]. Yet, pre-eclampsia related high blood pressure during pregnancy is also a leading cause of serious health complications in newborn babies [R5].
Researchers have discovered that women who consume folic acid supplements during pregnancy have lower risks of developing pre-eclampsia, compared to women participants who did not take folic acid supplements (the control group in the study) [R6].
Last, the efficiency of folic acid supplements in preventing pre-eclampsia has also been demonstrated in a larger study consisting of 3,247 women participants from the United States and Canada [R7].
1.3 Childhood Autism Spectrum Disorder
Folic acid supplements likely reduce the risk for children developing Childhood Autism Spectrum Disorder (ASD). Autism Spectrum Disorder is a condition associated with burdens in children emotional- and social-adaptation [R8].
In one study consisting of 85,176 children, 0.10% of children whose mothers used folic acid supplements developed ASD, compared to 0.21% of children whose mothers did not use folic acid supplements during pregnancy [R9]. This study suggests that when mothers use folic acid supplements during pregnancy, the risk for their children developing ASD is approximately halved.
Evidence supporting folic acid supplements for childhood ASD prevention has been published as recently as the year 2015 [R10].
1.4 Childhood Cognitive, Emotional & Behavior Effects
Folic Acid supplements during pregnancy seem to promote healthy neurodevelopment in newborn babies and young children.
One indicator of childhood neurodevelopment is the absence (or presence) of severe language delay in children – as children become older and enter different childhood development stages. “Severe language delay” refers to whether or not there is a much-longer-than-usual delay in children developing minimal ability to express themselves using basic language.
Researchers have concluded that severe delays in language expression occur less frequently in children whose mothers supplemented folic acid during pregnancy, compared to children whose mothers did not use this supplement [R11].
In a somewhat related research area, researchers discovered a lower risk for serious emotional problems in 3-year-old children whose mothers used folic during pregnancy [R12].
Part 2: Folic Acid in Diet & Supplement Recommendations
In the previous part, we learned about the benefits of folic acid supplements for pregnant women, developing fetuses, and newborn children. However, public policymakers have long been aware of the potential of this health strategy.
Notably, worldwide, most countries have some type of guidelines or recommendations regarding the use of folic acid supplements for women who might become pregnant.
Using this strategy for improving pregnancy outcomes, what has already been accomplished in the United States regarding pregnancy outcomes?
2.1 Nation-Wide Folic Acid Food Fortification Programs
Because there is strong evidence that folic acid is beneficial during pregnancy, the United States Food and Drugs Administration has implemented laws that regulate the fortification of foods with folic acid.
Food fortification actually means that extra folic acid is added by manufacturers to certain types of foods. Such national programs exist in order to improve adequate intake of folic acid levels in people’s diets – especially in pregnant women.
The introduction of folic acid food fortification programs has resulted in lower rates of neural tube defects across the United States [R13]. The occurrence of neural tube defects has decreased from 10.7 cases per 10,000 live births (years 1995 – 1996) to 7.0 cases per 10,000 live births (years 1999-2011) [R14].
In the continuity of such efforts, more recently the FDA has approved folic acid fortification of corn masa flour [R15]. This regulation allows manufacturers to include higher amounts of folic acid in this type of flour – which is widely used by the food industry.
2.2 Dietary Folic Acid Intake is Not Enough (Need for Supplements)
Folate is required for red blood cells synthesis. The most efficient way to increase folate levels in the body is via increased intake of folic acid. Once ingested, folic acid is converted into folate – a biologically active compound that stimulates the production of new red blood cells [R16].
As we discussed in the previous section, efforts to fortify food with folic acid have been somewhat effective in reducing neural tube defects in the United States.
However, diet on its own is likely not sufficient to fully cover pregnant women nutritional needs for folate intake.
Based on 2007-2012 data, one study found that 48% of childbearing-age women consumed folic acid solely from food, while 29% of women reported using folic acid supplements [R17].
In the same study, researchers also concluded that almost one quarter (1/4th) of non-pregnant women (age 13 to 49) have less-than-optimal folate levels measured in red blood cells [R17].
Overall, this is strong evidence for the need to supplement folic acid during pregnancy, even in the current-day era characterized by national folic acid food fortification programs.Understand the targeted reasons for using supplements in your diet. Meaningfully choose your supplements using the latest health science.Click To Tweet
Part 3: Folic Acid Timing Before & During Pregnancy
How can you optimize your intake of folic acid supplements, to make the most out of this health strategy?
When should you start taking folic acid supplements to maximize the potential health benefits?
3.1 Rate of Unintended (aka. Unplanned) Pregnancies
When discussing any pregnancy-related health topic (such as Folic Acid Supplements during pregnancy) there is one piece of the puzzle which is often overlooked. This is the significantly high rate of unintended (also known as unplanned) pregnancies in the United States.
In truth, the rate of unintended pregnancies has steadily decreased over the past years, from 51% in 2008 to 45% in 2011 [R18].
Following this trend, we can expect the current-day rate of unplanned pregnancies (in the year 2018) to be approximately 40% and 45% of all pregnancies occurring in the United States.
If you are a woman capable of becoming pregnant, this is something that you should bear in mind when making pregnancy-related health decisions.
3.2 Folic Acid in Pregnancy Recommendations
Several sources with high scientific authority have already recommended the use of folic acid supplements for pregnant women.
The American Congress of Obstetricians and Gynecologists support a minimum intake of 400 micrograms of folic acid supplement per day – for all women who are capable of becoming pregnant [R19].
Most recently in 2017, the US Preventative Task Force reaffirmed their recommendation to take 400 to 800 micrograms folic acid supplement per day – also for all women who are of childbearing age [R20].
3.3 Optimal Timing for Folic Acid Supplements in Pregnancy
Taking folic acid supplements at recommended amounts during pregnancy leads to almost fully metabolized folic acid into biologically active folate [R21]. This is true for measurements in maternal blood, as well as for measurement of blood found in fetal cords (blood that actually feeds the developing fetus) [R21].
This means that there are virtually no potential side effects caused by poor metabolism of folic acid supplements – for most pregnant women during the first three months of pregnancy (1st trimester).
In addition, according to recent scientific recommendations, women should focus on starting folic acid supplements at least one month prior to becoming pregnant. Folic acid is effective for preventing fetal growth restrictions as you continue with daily intake during the first trimester [R22].