The terms folate and folic acid are interchangeable. Folic acid simply refers to the manufactured form of folate; for example, as it is found in vitamin supplements. Folate is a water-soluble B vitamin, obtained entirely through diet and/or supplementation.
Folate plays an important role in the production and growth of healthy new cells, and is particularly important in embryonic development. In the general population, Folate deficiencies can result in ‘megaloblastic anaemia, where enlarged and immature red blood cells are present in the blood. Folate is particularly important for women of childbearing age or who are pregnant, as it can prevent major birth defects known as Neural Tube defects (NTD), including Spina Bifida and Anencephaly. These defects occur very early on in pregnancy, often before you are aware that you are pregnant. It is therefore important to keep your folate levels up, even if you are not specifically planning a pregnancy.
The connection between folic acid and neural tube defects (NTD’s) was made in the 1960’s. Richard Smithells and Elizabeth Hibbard noticed that mothers of babies born with these defects often had an impaired folate status. Smithell’s undertook a study where women who had previously had babies born with NTD’s were given multi-vitamins (containing 0.36mg of folic acid) daily from around the time of conception, and compared them to women who were already pregnant or who declined to take part. The results showed that the risk of a recurring NTD for women taking the multi-vitamin was around one seventh compared to those who weren’t. Following this, a large trial, known as the ‘MRC Vitamin Study’ was undertaken in 1983. The study revealed that taking 4mg of folic acid immediately before pregnancy could prevent about 80% of neural tube defects. The guidelines, (below), have subsequently evolved as knowledge of folic acid and NTD’s has developed.
The recommendation for pre-conception and pregnancy
The Royal Australia New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommend that folic acid be taken for a minimum of one month before conception and for the first 12 weeks of pregnancy. The recommended dose of folic acid is at least 0.4mg daily to aid the prevention of neural tube defects (NTD). Where there is an increased risk of NTD (e.g. anticonvulsant medication, pre-pregnancy diabetes mellitus, previous child or family history of NTD or BMI >30), a 5mg daily dose is recommended.
Women at increased risk of folate deficiency (e.g. multiple pregnancies, haemolytic anaemia) should take 5mg of folic acid throughout the pregnancy.
How to get adequate folate
There are many multivitamins on the market, both pregnancy specific and general. The large majority of these will have the recommended dose of 0.4mg to 0.5mg (or maybe labeled as 400mcg or 500mcg), so just check the label to make sure. If you have any of the conditions as outlined above, you will be advised to take the recommended dose of 5mg.
Folate also occurs naturally in foods such as leafy greens, including spinach, broccoli and salad greens, legumes, such as beans and chickpeas, whole grains and citrus fruit. In 2009 in Australia, it became mandatory for bread to undergo fortification with folic acid. Many breads now have the recommended daily intake of folic acid per serve.
For more information on folate in pregnancy, please visit this factsheet: http://www.genetics.edu.au/publications-and-resources/facts-sheets/fact-sheet-30-folate
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