Motherisk.org has recently published some new guidelines for folic acid supplementation before and during pregnancy. Previously, women who were pregnant or trying to get pregnant were told to take 0.4 mg per day to prevent neural tube defects. The new recommendation is to take 5 mg per day.
I was all set to write a post about what neural tube defects (NTDs) are, the causes, the risk factors, etc as a background to the Motherisk article. I got partway through the Wikipedia article, and discovered that this kind of research is not really necessarily the best idea for someone like me. Considering that after I read The Hot Zone in high school and was briefly convinced that every twinge, every runny nose, every cough were signs that I had Ebola, I should have known better.
Here’s a short summary of what I gleaned from the NTD article (here it is if you’re braver than me): A NTD is basically an opening that occurs in the spinal cord or brain, where the spinal cord doesn’t fuse properly in utero. Spina Bifida is the one I heard most about during my last pregnancy. NTDs are the most common form of birth defect and occur in about 1 in 1000 births in the US, and worldwide about 300,000 infants are born with NTDs. Common is a relative term here. For US moms, that’s around a 0.1% chance (assuming no other factors like previous history, genetics, etc). Pretty low.
What they’ve determined, though, is that folic acid deficiency seems to be a major contributor. According to the Motherisk article, studies showed that in women with high risk of NTDs, folic acid supplements reduced the rate of recurrence of NTDs by 72%. (here’s the cite given by Motherisk) The takeaway here is that folic acid is important.
We know that. That’s why our doctors and midwives have been telling us to take our folic acid. So why now the change? Why now are they advising us to up the dosage?
Apparently because women are not taking their vitamins. From the article:
Compliance is less than optimal among women using prenatal vitamins, rendering many women unprotected against neural tube defects. Taking a higher dose of folate will allow achievement of protective folate levels, even with partial compliance.”
I will be the first one to say this: Guilty as Charged. When I was pregnant with my daughter, I did not take prenatals. I happily took them prior to getting pregnant, but as soon as the HG hit I stopped. There was just something about them that did not sit right. Maybe it was the whole trying to swallow a giant horse pill thing, hmm? Yeah, that’d probably be a big part of it. Once I turned the corner mid-2nd trimester I was able to take Flintstone vitamins, but that was it.
Gearing up for things a second time around, I know what’s coming. I know I likely won’t be able to take vitamins of any sort after a certain point. I’m definitely in the non-compliance class.
It’s never as simple, though, as just taking more vitamins. You need to treat vitamins with respect. Some vitamins, if taken in too high doses, can cause pretty serious problems. Vitamin A is a good example of this. Based off the article, though, the risks for taking high doses of Folic Acid are pretty minimal, the main one being that it could potentially mask a B12 deficiency (pernicious anemia). They are there, though, so I would really encourage you to read through that section of the article and talk it over with your doctor before swallowing folic acid pills by the handful.
In talking to my doctor, she agreed that it might be a good idea for me to take the 5 mg dose considering my circumstances. She did tell me that the body won’t store folic acid over long periods, so if I’m not able to take it at all during the 1st trimester, it won’t be there by the 2nd trimester. Additionally, high doses can cause stomach upset, so when I do get pregnant at some point, she’ll want me to reduce my intake. No sense in upsetting my stomach with vitamins when it’ll be upset enough on its own. So now I have in my hot little hand a sparkly new prescription for 5 mg per day of folic acid.
Also, can anyone tell me what the funky little symbol is that I see on the back of my vitamins? It looks like a drunken U: µ. Is that just a fancy way to write mg?