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folate

Folate (folic acid) is a B-vitamin that is necessary for normal development of the nervous system in a first trimester fetus in the critical time right after conception. This fact has been established beyond doubt in the last few years. Supplementation of potential mothers' diets with 0.4 milligrams (mg) of folate a day prevents up to 85% of serious malfomations of the nervous system, known as neural tube defects.

The nervous system of a fetus forms first as a flat plate of tissue along the back. This plate curls up into a tube and ultimately "zips up," to form a completely tubular structure. This hollow tube-like structure of the brain and spinal cord is preserved in the adult brain as the fluid-filled ventricular spaces within the brain and a tiny central canal that runs down the center of the spinal cord.

Neural tube defects

• include spina bifida and anencephaly (partial or complete absence of the brain)
• affect about 4,000 babies a year
• 95% of these defects occur with no prior family history of such problems
• most defects are isolated - that is, they occur in otherwise normal children

The recommendation is that all sexually active women of childbearing age, whether they plan to become pregnant or not, should take 0.4 mg of folate a day. The reasoning behind this recommendation is that

• at least 50% of pregnancies are unplanned
• closure of the neural tube occurs by 26 to 28 days after conception - before a woman is typically aware that she is pregnant

Recommendations are modified for women who have already had a child with a neural tube defect:

• Women who have had a child with a neural tube defect should take 10 times the ordinary dose of folate, 4 mg - beginning a month before planned conception and for three months after conception
• These women should take a specific folic acid supplement, NOT extra multivitamins, since they would potentially receive harmful doses of vitamin A and some others
• High dose folate supplementation does NOT prevent all subsequent neural tube defects, so these pregancies should be begun after good counselling and must be closely monitored

 Dietary sources of folate include

• dark, leafy vegetables
• citrus fruits
• liver
• fortified cereals
• legumes

However, prospective mothers should not rely on diet alone, and should take folate supplementation.

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