Why are folic acid tablets given out for free when registering for marriage?

This is the 5082nd article of Da Yi Xiao Hu

Recently, some young friends have been asking online, "Why are folic acid tablets given out for free when registering for marriage?" Another asked, "Should I take the folic acid given out when registering for marriage right away? What is it for? Is it a promotion or an inducement to childbirth?"

As early as 2000 years ago, the country had already implemented measures to distribute folic acid for free. At that time, it was still the era of family planning that advocated the one-child policy, and there was no intention to induce childbirth. In fact, taking folic acid has nothing to do with increasing the chance of pregnancy. However, taking folic acid is closely related to improving the health level and quality of life of the fetus, newborns, and even all mankind after pregnancy! In ancient and modern times, both in China and abroad, getting married and having children is a common human nature. Regarding the relationship between folic acid and marriage and childbearing, we really need to learn more popular science knowledge.

1. Why does the government distribute folic acid for free? Where does it distribute it?

In order to prevent birth defects and improve the quality of the newborn population, my country began to promote the use of folic acid in the childbearing population in 1993. The state widely publicized this measure through fertility-related institutions at all levels, and promoted the use of 0.4 mg folic acid supplements per day among newlyweds and women preparing for pregnancy. After the implementation of this policy, the incidence of neural tube defects in my country has been significantly reduced, reducing the birth of 50,000 children with congenital malformations each year.

In order to improve the health of mothers and infants and avoid the threat of folic acid deficiency during pregnancy to human health, survival and development, maternal and child health care institutions and obstetrics and gynecology clinics in community health service centers will distribute folic acid tablets for free for 3-6 months. The marriage registration departments of civil affairs bureaus in many places will also distribute folic acid tablets for free. Pregnant women can go to the local maternal and child health care hospital to receive them. When receiving them, they need to register the personal ID number and residential address of the expectant mother, but they are not required to provide a marriage certificate.

2. Folic acid and its effects on the human body

Folic acid, also known as vitamin B9, is named after the spinach leaves it was found in. It is a water-soluble B vitamin that cannot be synthesized or stored by the human body and must be obtained from vegetables and fruits. For pregnant mothers, folic acid is an essential nutrient for fetal growth and for maintaining their own health. Timely supplementation of an appropriate amount of folic acid during the pre-pregnancy period and during pregnancy can effectively improve the quality of the fertilized egg and the fetus, help prevent neural tube malformations, Down syndrome, congenital heart disease, cleft lip and other diseases in infants, and can also prevent premature birth and megaloblastic anemia during pregnancy.

3. When preparing for pregnancy, when should I take folic acid?

For normal women of childbearing age without high-risk factors, it is recommended to supplement 0.4 mg or 0.8 mg of folic acid daily starting at least 3 months before pregnancy, and at least until the 3rd month of pregnancy. After the 3rd month of pregnancy, you can continue to supplement folic acid 0.4 mg daily until the baby is born, especially for pregnant mothers who have poor appetite, picky eating, and cannot guarantee the nutritional needs of both mother and child. If nutritional needs, the mother can continue to take folic acid in the first 3 months after the baby is born, and can also take it in the second and third trimesters and even during breastfeeding.

Half an hour after a meal is one of the best times for the human body to absorb drugs. It is recommended that expectant mothers and fathers take 0.4 mg or 0.8 mg of folic acid at a fixed, convenient and optimal time every day. If vitamin C is supplemented at the same time, the two need to be taken at least 30 minutes apart. In general, 0.4 mg of folic acid is taken per day. For those with a history of adverse pregnancy and childbirth such as neural tube defects, the dosage can be increased to 0.8 mg (2 tablets).

4. “Start taking folic acid at least 3 months before pregnancy”, when exactly should you start?

The time of “sperm-egg fusion-pregnancy” cannot be accurately determined, so how do we determine the specific time of “taking folic acid orally at least 3 months before pregnancy”?

Folic acid is an essential water-soluble vitamin for maintaining human health. It will be quickly excreted from the body after being ingested and will not accumulate too much. Considering that folic acid deficiency during pregnancy will bring multiple health risks to both the fetus and the pregnant mother, most scholars advocate that it is better to supplement more folic acid during pregnancy rather than less! For most healthy expectant parents, you can take the measure of "taking folic acid for three months before starting to get pregnant." The specific approach can be as follows: After preparing for pregnancy and welcoming a new life, take contraception first, and the couple will take folic acid tablets orally for 3 months before starting to prepare for pregnancy. The expectant father continues to take folic acid tablets until pregnancy; the expectant mother continues to take folic acid tablets orally for at least 3 months after pregnancy. After three months, consider whether to continue taking folic acid based on her own folic acid metabolism.

5. Are there any side effects of excessive folic acid supplementation?

Folic acid supplementation is not unconditional, the more the better. In many cases, scientific supplementation is required according to the situation. In special cases, you need to go to the obstetrics and gynecology clinic and follow the doctor's advice to supplement. For some expectant mothers with abnormal methylenetetrahydrofolate reductase metabolism, the oral dose of folic acid needs to be increased before pregnancy. Generally speaking, the effective and safe oral dose of folic acid is 0.4-0.8mg per day. A daily dose greater than 1mg may cause health risks.

6. Why should folic acid be taken orally starting three months before pregnancy?

The egg in the mother's body that nurtures new life develops slowly. It takes a long three months for the immature follicle to develop into a mature follicle. The development of sperm and egg, and the development of the fertilized egg after the combination of sperm and egg, all require folic acid. The critical period for the differentiation and development of important tissues and organs such as the human neural tube and cardiovascular system is in the first three months after pregnancy. Therefore, the three months before and after pregnancy are critical periods for fetal development and human health. Supplementing folic acid in advance can avoid birth defects caused by folic acid deficiency.

7. Which foods are rich in folic acid?

Under normal circumstances, a balanced diet is the first choice to improve folic acid nutrition. The rational use of folic acid supplements and fortified foods before and after pregnancy is an effective measure to meet the physiological needs of nurturing life and prevent birth defects. Foods rich in folic acid include quinoa, dried soybeans or beans, bean curd, spinach, fennel, amaranth, animal liver, lean meat, etc. Green vegetables such as rapeseed, spinach, tomatoes, carrots, lentils, mushrooms, etc. are also rich in folic acid.

Author: Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University

Pediatrics Chief Physician Xu Lingmin