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The relation between congenital defects and folic acid?

May 28, 2019

Every year, 8 million children are born with a congenital malformation or anomaly; 25,000 of these children are born in Italy alone. The Italian Society of Neonatology (SIN) draws attention to the problem and asks for more prevention among couples who wish to have children. In percentage terms, the frequency of congenital defects is estimated at around 5%, i.e. one child in every 20 born presents a malformation, from the most frequent, such as heart abnormalities, to the rarest, such as Down’s syndrome, spina bifida and the ‘harelip’, to the rarest, such as anencephaly, or lack of brain development. We talked about it with Dr. Maria Rosaria Parisen Toldin, gynecologist at Humanitas.


Can folic acid reduce the risk of malformations in the newborn?

“Children’s organs are formed during the first weeks of pregnancy, even before the woman is aware of being pregnant – says the president of Sin Fabio Mosca. – What is missing is a prevention policy that starts before the pregnancy, that is, as soon as the couple begins to think they have a child”. A single, but very indicative, fact concerns the intake of folic acid before conception, which reduces the risk of neural tube defects, but in Italy only one in four women takes folic acid before the beginning of pregnancy. Folic acid and folates are B vitamins, also known as vitamin B9. The word comes from the Latin folium, or leaf. In the 1940s, an American scholar was the first to use the term “folic acid” to indicate substances extracted from spinach leaves that had proved effective against certain types of anaemia. Folates must be introduced through the diet, as our body produces them in very limited quantities. Folic acid and folates are involved in the synthesis of molecules such as DNA, RNA and proteins. A deficiency of these vitamins can lead to forms of anaemia and increase the risk of severe foetal malformations, such as neural tube defects, cardiovascular defects, lip and palate malformations, urinary tract defects and limb reduction.


Folic acid in the pregnancy, different doses at each stage

If a diet rich in fruit, vegetables and legumes containing folates can help to reduce the incidence of congenital malformations, it is also worth noting that the diet alone is not always sufficient to cover the daily needs. Therefore, if you are planning to become pregnant, you should supplement your diet with folic acid tablets. Numerous studies have shown that the supplementation of folic acid during pregnancy is effective in the primary prevention of neural tube defects allowing a reduction in risk of up to 70%. The Ministry of Health itself, on its website, has indicated the recommended daily doses of folic acid:

Before a pregnancy

To reduce the risk of congenital malformations such as spina bifida, anencephaly and encephalocele, it is necessary for the woman to take 0.4 mg of folic acid per day, in the form of supplements, while she is planning to become pregnant (at least 1 month before).

During pregnancy

The daily need for folates increases for pregnant women to 0.6 mg per day since the fetus draws on maternal resources for its own development. Therefore, the intake of the folic acid should continue until at least the third month of gestation.

During breastfeeding

The daily requirement for a breastfeeding mother is 0.5 mg of folates, in order to restore the losses that occur with breast milk.


The word of Humanitas

Dr. Parisen listed some indications for taking folic acid supplements and answered some questions.

How much?

“Many studies have confirmed that a dose between 400 and 800 mcg/day prevents neural tube defects. No study has shown that a dose greater than 1 mg/day leads to a further reduction – said the specialist -. Taking a higher dose up to 4-5 mg/day is recommended only in women at risk (with previous pregnancies with neural tube defects or repeated miscarriages, suffering from diabetes, celiac disease or other pathologies from malabsorption or taking antiepileptic drugs or antagonists of folic acid)”.


“In theory the folic acid is ideal for all fertile women or in any case when you decide to look for a pregnancy, because the closure of the neural tube takes place approximately 6 weeks after implantation (between the 17th and 29th day of conception) – added the doctor -. The ideal is 2-3 months before conception”.

What costs?

“Folic acid is prescribed free of charge”.

Are there any risks associated with excessive doses?

“Women of childbearing age should be cautious and should not exceed the recommended daily dose, as there is much clinical evidence to confirm that excessive intake of folic acid can lead to changes in the neurological development of the fetus – concluded Parisen -. The actual damage is unknown. More studies are needed to determine the most effective dose of folic acid, the daily threshold limit of intake of folic acid and the ideal period of preventive supplementation for optimal neurological development”.

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