Folate: A Key Ingredient to Problem-Free Pregnancy

By Bronwyn Long May 05, 2015

asparagusYou know poor diet hurts your health, but did you know it can put your future child at risk before you even conceive? 

Roughly one in every 33 infants is born with a defect in the United States (10). Poor nutrition is one of multiple causes for pregnancy complications. In particular, women need higher levels of a vitamin called folate before conception to deliver a healthy baby, but the body cannot produce folate on its own; we only get it from eating certain foods. For this reason, some foods are fortified with a form of folate called folic acid, but is eating a bowl of O's going to cut it?

Folate: What You Need to Know

Folate is a water-soluble (dissolves in water) essential B vitamin that plays a crucial role in the production of new cells—super important for maintaining health. Folate cannot be produced by the body, so we get it through diet alone, and it is easily depleted within months or even weeks of inadequate dietary intake. We need to get a consistent supply of folate from our diet to stay healthy. The stakes are even higher for women because healthy folate levels are critical for a healthy pregnancy.

Prepare for the Unexpected

Folate deficiency is a major cause of neural tube defects (NTD)—serious birth defects of the brain or spinal cord that can cause lifelong disability or even death (11). The worst part is that NTDs occur in the first month of pregnancy, before you might even know you're pregnant. Half of all pregnancies in the U.S. are unplanned (12), so waiting to improve folate levels after the fact can be too late (13). Having healthy folate levels is particularly important at least three months before and after conceiving. 

To complicate things further, most women have their lowest folate levels exactly when they need it the most— during their reproductive years. It's not from menstruation, as you might expect; studies show that folate levels actually do not fluctuate much over the course of the menstrual cycle (5). Similarly, most women will not experience a surge in folate levels immediately after menopause. When it comes to oral contraceptives, mixed results still leave us scratching our heads about how folate levels might be affected (6).

So, why are women particularly low on folate during these critical years? The reason remains a mystery, but the solution to the problem is quite clear. Research suggests that consuming a daily dose of 400 to 800 mcg folic acid is the surest way women can avoid delivering a baby with NTDs (12). In fact, it is projected that 50% to 70% of NTDs could be prevented if women got 400 mcg of folic acid daily, before and during pregnancy (14). Supplements and foods fortified with folic acid are the easiest way to meet this recommendation.

Pregnancy

While folate is arguably most important during those first few weeks of development, it continues to be an important nutrient all the way through to delivery. The body's need for folate increases during pregnancy. This, in combination with hemodilution (blood dilution) causes lower folate levels during pregnancy, possibly up to 50% without folic acid supplementation (7). Folate levels that fall in the low end of normal (3-5.9 ng/mL) are associated with high-risk pregnancies (17).

A Public Health Concern

Every year, 3,000 babies in the U.S. and 300,000 worldwide are born with NTDs (13). Before the mid-nineties, the NTD rate was even higher for American babies. Folate deficiency was a real concern, so the Food and Drug Administration (FDA) required all enriched grain products (like cereal or bread) to be fortified with folic acid, a form of folate used more easily by the body (16). The program was complete in 1998 and correlated to a drastic drop in both the prevalence of folate deficiency and in the rate of NTDs in the initial years (1).

However, average folate levels have actually been decreasing in more recent years, and most women in the U.S. do not attain the recommended daily amount of folic acid (14). The growing popularity of low-carb diets could be a source of the problem (2).

Does that mean you should start loading on carbs? Not necessarily, but it does highlight the need for understanding what's happening in your blood and how your folate levels can shift over time.

Lifetime Trends

Folate levels fluctuate over the course of a lifetime. In both men and women, folate tends to peak during childhood and after age sixty (2). This could be due to greater consumption of fortified foods during these years, as well as more frequent use of multivitamins, but the exact reason is unknown (3). Multiple studies also show that folate absorption increases more than two-fold in older men and women (4). Getting a blood test is the surest way to know your folate status.

Folate & Your Health



In addition to protecting your potential future baby from NTDs, folate is essential for different aspects of your personal health. Both men and women need folate for:

  • Producing and maintaining healthy new cells, including red blood cells
  • Using, breaking down, and creating new proteins
  • Protection against some cancers, cardiovascular disease, and cognitive decline


For men, healthy folate levels have been linked to improving sperm counts and motility.

If folate levels remain abnormal for ongoing periods of time, it can pose a direct threat to your personal health; not just your future baby's.

Too Little Folate

Ongoing low levels of folate have been linked to:

  • Anemia
  • Certain cancers
  • Psychiatric disorders
  • Cognitive impairment in the elderly
  • Gray hair
  • Mouth ulcers

Too Much Folate

Having too much folate can cause problems as well. It can mask vitamin B12 deficiencies, which can lead to nerve damage. Higher folate levels may also increase cancer risk, though research has shown mixed results (18, 19). While getting too much folic acid from natural foods is unlikely, you should pay attention to what you get from fortified foods and supplements—do not consume more than 1,000 mcg of folic acid a day unless it is advised by your doctor (12).


Folate VS. Folic Acid



Folate appears naturally in certain foods (like asparagus and lentils), whereas folic acid is the man-made version of folate that gets added to enriched grains (like bread). The body does not use folate as easily as folic acid, so it is much harder to maintain healthy levels from natural foods alone (6, 16). Taking folic acid supplements or eating fortified foods can be far more helpful. It is recommended that all women capable of getting pregnant take 400 micrograms of synthetic folic acid daily, along with getting folate from natural foods (15).

Your Action Plan

Everyone needs to maintain healthy folate levels to stay in tip-top shape. The need is even greater for women and older adults. The standard recommendation is that all women capable of becoming pregnant take at least 400 micrograms of folic acid a day, along with eating a balanced diet. Never consume more than 1,000 mcg of folic acid daily, unless it is advised by your doctor. Remember—having healthy folate levels is particularly important at least three months before and after getting pregnant, so staying consistent with your diet over time is critical. If you're low in folate, eating certain foods can help, including:

  • Enriched grains, e.g. cereals, breads, pastas, and rice
  • Green vegetables, e.g. asparagus and spinach
  • Lentils and chickpeas
  • Citrus fruits

Just one serving of many breakfast cereals can give you the recommended daily amount of folic acid. Still, it may be difficult to get all the daily nutrition you need from food alone, but supplements may close the gap.

Folate_Nutrition_

(Image Source: Office on Women's Health)

So, should you stock up on cereal or do you need to bring your folate levels down? You can't act on what you don't know, so the most effective way to take your health in your hands is to get your blood checked. Your test results will give you the facts about your health, including your levels of folate and other important markers.

When it comes to health, there are a lot of unknowns.


Keep track of what you can control.
 

Check your blood levels today

 

 

 

Edited and additional authoring by Katya Margolin

References:
1.Pfeiffer CM, Johnson CL, Jain RB, et al. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988–2004. Am. J. Clin. Nutr. 2007;86:718–727.
 
2.Mc Dowell MA, Lacher DA, Pfeiffer CM, et al. (2008) Blood folate levels: The latest NHANES results. NCHS Data Brief 6: 1–7.
 
3.Smith AD, Kim YI, Refsum H. Is folic acid good for everyone? Am J Clin Nutr. 2008;87:517–533.
 
4.Wald NJ, Law MR, Morris JK, et al. Quantifying the effect of folic acid. Lancet. 2001;358:2069–2073.
 
5.Pietarinen GJ, Leichter J, Pratt RF. Dietary folate intake and concentration of folate in serum and erythrocytes in women using oral contraceptives. Am J Clin Nutr. 1977 Mar;30(3):375–380.

 
6.Yang TL, Hung J, Caudill MA, et al. A long-term controlled feeding study in young women supports the validity of the 1.7 multiplier in the dietary folate equivalency equation. J Nutr. 2005;135(5):1139-1145. http://jn.nutrition.org/content/135/5/1139.full
 
7.Ball EW, Giles C. Folic acid and vitamin B12 levels in pregnancy and their relation to megaloblastic anemia. J Clin Pathol. 1964 Mar;17:165–174.
  
8.Castillo-Lancellotti C, Tur JA, Uauy R. Impact of folic acid fortification of flour on neural tube defects: a systematic review. Public Health Nutr. 2013;16(5):901-11. http://www.ncbi.nlm.nih.gov/pubmed/22850218
 
9.Bell KN, Oakley GP Jr. Update on prevention of folic acid-preventable spina bifida and anencephaly. Birth Defects Res A Clin Mol Teratol. 2009;85(1):102-7. http://www.ncbi.nlm.nih.gov/pubmed/19067404/ 

 
10."Birth Defects: Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Oct 2014. Web. 22 April 2015. http://www.cdc.gov/ncbddd/birthdefects/data.html.
 
11."Birth Defects COUNT." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 24 December 2014. Web. 25 April 2015. http://www.cdc.gov/ncbddd/folicacid/global.html
 
12."Folic Acid Fact Sheet." Womenshealth.gov. 16 July 2012. Web. 23 April 2015. http://womenshealth.gov/publications/our-publications/fact-sheet/folic-acid.html
 
13.“Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16, Jan 2015. Web. April 29 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a2.htm
 
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 "Data and Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Dec 2014. Web. 25 April 2015. http://www.cdc.gov/ncbddd/folicacid/data.html

 
15."Folic Acid: Questions and Answers." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Dec 2014. Web. 25 April 2015. http://www.cdc.gov/ncbddd/folicacid/faqs.html 

 
16.Simpson JL, Bailey LB, Pietrzik K, et al. Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficiency or excess. Part I—Folate, Vitamin B12, Vitamin B6. J Matern Fetal Neonatal Med. 2010;23(12):1323-43. http://www.ncbi.nlm.nih.gov/pubmed/20373888
 
17.“Serum and red blood cell folate concentrations for assessing folate status in population.” World Health Organization. World Health Organization. 2012. April 29 2015.http://apps.who.int/iris/bitstream/10665/75584/1/WHO_NMH_NHD_EPG_12.1_eng.pdf
 
18.de Batlle J, Ferrari P, Chajes V, et al. Dietary Folate Intake and Breast Cancer Risk: European Prospective Investigation Into Cancer and Nutrition. JNCI J Natl Cancer Inst. 2015; 107 (1): dju367 doi:10.1093/jnci/dju367
 
19.Qin X, Cui Y, Shen L, et al. Folic acid supplementation and cancer risk: a meta-analysis of randomized controlled trials. Int J Cancer. 2013;133:1033–1041. doi: 10.1002/ijc.28038.


 

 

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