The leader in preventing pregnancy diseases

Author: Zhao Aimei, deputy chief physician of Shandong Liaocheng Dongchangfu District Maternal and Child Health Hospital

Reviewer: Cai Rui, Chief Physician, Dongchangfu District Maternal and Child Health Hospital, Liaocheng City, Shandong Province

Many pregnant mothers are familiar with folic acid and know that folic acid supplementation is good for fetal development. However, they do not have a systematic and clear understanding of these questions: "What is folic acid? Why do we need to supplement folic acid before and after pregnancy? How to supplement folic acid correctly?" Let's talk about folic acid, the "leader" in preventing pregnancy diseases.

1. What exactly is folic acid?

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Folic acid, also known as pteroylglutamic acid, is a water-soluble B vitamin.

Folic acid was first extracted and purified by scientists as a growth factor from spinach, and was named after its abundant content in green leaves.

Folic acid is involved in the metabolism of amino acids and nucleic acids. It is an essential substance for cell proliferation, tissue differentiation and body growth and development. It is also an indispensable nutrient in the process of embryonic development.

2. Why do we need to supplement folic acid before and after pregnancy?

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1. Women's body needs more folic acid after pregnancy

During pregnancy, women need 4,000 times more folic acid per day (about 0.6 mg) than when they are not pregnant. However, in the diet of women of childbearing age in my country, the average daily folic acid intake is less than 0.26 mg. If the loss during cooking is deducted, the actual intake is less than 0.2 mg, which is far below the body's requirement.

Some people may think that many foods contain folic acid, especially green leafy vegetables, fruits and animal livers. Can I just eat more of these foods? Eating more can certainly supplement a certain amount of folic acid, but this amount is far from enough. In addition, folic acid is very unstable, and the loss rate during food storage, processing and cooking is as high as 90%. Therefore, it is difficult for pregnant women to supplement enough folic acid simply from food.

2. Folic acid deficiency during pregnancy can increase the risk of disease for both the pregnant woman and the fetus

Studies have shown that if the pregnant mother lacks folic acid during pregnancy, it can easily lead to abnormal neural tube development in the fetus, which in turn can lead to fatal neurological malformations such as anencephaly, spina bifida and meningocele. It can also increase the risk of newborns with Down syndrome, congenital heart disease, cleft lip and palate, urinary system malformations, fetal growth restriction, limb deficiency, stillbirth and other diseases.

Folic acid deficiency during pregnancy can also increase the risk of maternal hyperhomocysteinemia, threatened abortion, premature birth, megaloblastic anemia, gestational hypertension, cardiovascular disease, etc.

3. How to supplement folic acid correctly?

1. When is the appropriate time to supplement folic acid?

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The fetal neural tube closure is basically completed 26 to 28 days after conception, which is 6 weeks of pregnancy. Therefore, women who are preparing for pregnancy or have just become pregnant should supplement folic acid as early as possible to effectively prevent abnormal fetal neural tube development. Regarding the time to take folic acid, the national recommendation is to start taking it 3 months before preparing for pregnancy and continue until 3 months after pregnancy.

It is recommended that those who are planning to conceive start taking folic acid supplements three months before they are planning to conceive . For women who become pregnant unexpectedly without any preparation, they should start taking folic acid supplements daily as soon as they discover they are pregnant.

2. How much folic acid should I supplement daily?

The World Health Organization recommends that pregnant women take 0.4 mg of folic acid daily. However, it must be emphasized that long-term use of folic acid requires appropriate daily dosage under the guidance of a doctor.

IV. Supplementary guidance for pregnancy preparation, pregnancy and postpartum period

1. Women preparing for pregnancy or in early pregnancy

1. General population

(1) For women without high-risk factors, it is recommended that they take a folic acid supplement of 0.4 or 0.8 mg/day starting from the time of possible pregnancy or at least 3 months before pregnancy until the 3rd month of pregnancy.

(2) Personalized supplementation: Women with the following conditions may increase the supplement dosage or extend the pre-pregnancy supplementation time as appropriate.

①Live in the northern region, especially in rural areas of the north.

②The proportion of fresh vegetables and fruits in the dietary structure is low.

③Low folic acid levels in the blood.

④The preparation time for pregnancy is short.

(3) It is recommended that women who are planning to become pregnant or in early pregnancy eat more foods rich in folic acid, such as green leafy vegetables and fresh fruits, develop a healthy lifestyle, and maintain a reasonable body weight, thereby reducing the risk of neural tube defects in the fetus.

2. Special Populations

(1) For women with a history of neural tube defects, it is recommended to supplement folic acid at 4 mg/day starting from the time of possible pregnancy or at least 1 month before pregnancy until the 3rd month of pregnancy. Due to the domestic dosage form, folic acid 5 mg/day can be supplemented.

(2) If one of the spouses suffers from neural tube defects, or the husband has a history of giving birth to a child with neural tube defects, it is recommended that women who are planning to become pregnant take a folic acid supplement of 4 mg/day starting from the time of possible pregnancy or at least one month before pregnancy, until the third month of pregnancy. Due to the domestic dosage form, folic acid can be supplemented with 5 mg/day.

(3) Women with congenital hydrocephalus, congenital heart disease, cleft lip and palate, limb defects, urinary system defects, or a family history of the above defects, or a first- or second-degree relative with a history of neural tube defects, are advised to take folic acid supplements of 0.8 to 1.0 mg/day starting from the time of possible pregnancy or at least 3 months before pregnancy until the 3rd month of pregnancy.

(4) Women who suffer from diabetes, obesity, epilepsy, gastrointestinal malabsorption diseases, or are taking drugs that increase the risk of fetal neural tube defects (such as carbamazepine, phenytoin sodium, metformin, etc.) are advised to supplement folic acid at 0.8-1.0 mg/day from the time of possible pregnancy or at least 3 months before pregnancy until the 3rd month of pregnancy.

(5) For women with hyperhomocysteinemia, it is recommended to supplement folic acid by at least 5 mg/day and wait until the serum level of homocysteine ​​drops to normal before conceiving. Supplement folic acid by 5 mg/day should be continued until the third month of pregnancy.

The above dosage is for reference only. Please take it under the guidance of a professional physician.

(II) Mid- to late-pregnancy and breastfeeding

It is recommended that in addition to regular intake of foods rich in folic acid, continue to supplement with the recommended dose of 0.4 mg/day.

Warm reminder : There are many types of folic acid products currently sold on the market, and there are certain differences in quality. For safety reasons, pregnant women should make reasonable choices under the guidance of clinical physicians and not buy and take them at will.