Baby health: Importance of taking folic acid during childbearing years

Andrea Mara learns why all women of childbearing age should take folic acid — even those who aren’t planning to get pregnant right now.

If I think back to my new year’s resolutions before I had children, I imagine they were mostly about learning Italian, trying a wine-tasting course, and buying fewer shoes.

With a decade of motherhood behind me, I can’t remember precise details, but I’m certain taking folic acid wasn’t up there.

I had heard you’re supposed to take it if you’re of childbearing age, but I knew I wasn’t ready for kids so, as far as I was concerned, it didn’t apply to me.

And it’s people like my former self that Safefood are trying to target in their campaign to increase awareness about folic acid — people not planning to start families, who may nevertheless find themselves pregnant.

It’s a tricky message — take this supplement in case you become pregnant, even if you’re absolutely certain you have no intention of becoming pregnant.

And it’s even more challenging when the reasons behind the advice are not clear — I remember being aware that women were supposed to take folic acid, but I had no idea why.

Ten years and three kids later, I do know why we’re supposed to take folic acid, but only through writing about it here. So what are the facts? Why is it so important to take folic acid, and why before you become pregnant?

Folate (taken via folic acid supplements) is needed to support the effective closure of the neural tube of the spine and brain, which happens very early in pregnancy.

The incomplete closure of the neural tube can lead to the development of a number of serious health conditions in the unborn child called neural tube defects (NTDs). The two most common NTDs are anencephaly and spina bifida.

A recent Safefood report found that almost all women take folic acid once they discover they are pregnant, but this is on average 5.5 weeks into the pregnancy.

Folate levels need to be increased from conception, and because many pregnancies are unplanned, this isn’t happening. The report found that one third of women in Ireland are not meeting World Health Organisation recommended folate levels in early pregnancy.

“Up to half of all pregnancies are unintended and by the time the woman realises that she is pregnant, most if not all of the spinal cord development has already happened, so there is a definite argument to be had for all women of childbearing age taking folic acid,” explains Dr Shirley McQuade, medical director of the Dublin Well Woman Centre.

“Approximately one in 1,000 babies in Ireland are born with spina bifida. The estimate is that this would be reduced by 75% if all women had folic acid supplementation before and during the first 12 weeks of pregnancy.”

The Well Woman Centre has had a Pre-pregnancy Consultation listed as one of their services for the last 20 years or more — looking at lifestyle, health issues, and checking rubella immunity.

“As part of the discussion, we advise all women considering a pregnancy to start taking daily folic acid supplements at least three months before trying to conceive and then for the first three months of the pregnancy.”

But don’t we get folate through food?

“No, if you’re talking about reducing the incidence of neural tube defects, it’s not possible to get sufficient amounts from food that isn’t fortified,” says maternity services dietitian Sinéad Curran.

“Only folic acid can effectively raise blood levels enough to protect against neural tube defects. There are a few reasons why, and with nutrition, as with relationships, ‘it’s complicated’.”

Although there are many different types of folates in foods like green leafy veg, beans, nuts and seeds, they are notoriously temperamental.

“Naturally occurring folates are easily destroyed by light, by heat, by bruising — so normal things like storing, washing, preparing, and cooking food all reduce the natural folate content.”

Then there is the complexity of the way we absorb nutrients, says Curran.

“How much folate you can take in depends on what foods they are in and how you digest those foods.”

So how is folic acid different? “Folic acid is the stable, reliably-absorbed, synthetic form of folate — like a good, steady partner.

"We know that if there’s folic acid in a food it won’t be affected by cooking the way that natural folates are, and that it will bring up your blood cell levels in a predictable way.”

She believes all women of childbearing age should take folic acid. “I feel strongly that folic acid is a women’s health vitamin, and that until there is mandatory fortification of staple foods, all women should be taking it daily.”

Is there a risk that the message treats women as apparatus for pregnancy, whether they intend to have children or not?

“No-one is telling women to get pregnant, or that having children is their only purpose, far from it. But people do have sex at all ages and stages, and women do sometimes get pregnant as a result, regardless of their intention,” says Curran.

“It’s such a small thing to do that can have such a big impact with no discernible downside — what better can you say about a new year’s resolution?”