What Is A Neural Tube
The neural tube is one of the first things your baby will grow. It will become your babys brain and spinal cord and the bones that enclose them. The neural tube is formed in the first four to six weeks of pregnancy.
A neural tube defect can happen when something goes wrong in the development of a babys neural tube. This can cause a range of disabilities including loss of bladder and bowel control, and paralysis of the legs. In some cases, the effects can be more severe.
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Vitamin Supplementation For All Women Who Could Become Pregnant
Considering that the level of intake of folic acid from fortified foods is estimated to be no more than 100 to 200 mcg per dayFootnote 9, and recognizing that many pregnancies are unplanned, all women who could become pregnant should take a multivitamin containing 400 mcg of folic acid daily. This is in addition to the dietary folate provided by a varied diet. Having women supplement their diets with folic acid between pregnancies can help reduce the risk of NTDs in subsequent births.
Some women, such as those who have had a previous NTD affected pregnancy and those with a near relative who has a NTD, are at higher risk of having a NTD-affected pregnancy. They may need more than 400 mcg of folic acid daily . These women should be assessed early and advised on the steps to take to prepare for a healthy pregnancy.
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Best With Methylated Folate: Megafood Baby & Me 2 Prenatal Vitamins
Folate is a key nutrient for women during their reproductive years, but it’s important to get the right form. Many brands use folic acid, the synthetic form of folate, but this form isn’t necessarily the most bioavailable for everyone. For this reason, whether you have the MTHFR mutation or not, it’s important to select a prenatal vitamin with methylated folate.
Megafood’s Baby & Me 2 contains 600 micrograms of L-5-methyltetrahydrofolate or 170 percent of the daily recommended value for pregnant women.
Megafood is one of the most trusted brands in the supplement industry because of its commitment to transparency. Their products are certified glyphosate-, GMO-, soy-, gluten-, and dairy-free and have been tested for over 125 pesticides and herbicides.
When you’re pregnant, your iron needs increase by 50 percent18 milligrams for adult women to 27 milligrams per day for pregnant adult women. The growing baby requires adequate iron to support the healthy growth of cells, tissues, and organs and mom needs extra iron to support the increase in blood volume when pregnant.
The extra red blood cells that are produced carry oxygen to the baby and, without enough iron, mom can develop iron-deficiency anemia which has been associated with increased risk of low-birth-weight infants, premature delivery, and infant mortality.
When To Start Taking Prenatal Vitamins
The best time to start taking prenatal vitamins is before conception. Folic acid is especially important. You should begin taking a folic acid supplement at least 1 month before you try to get pregnant to prevent birth defects.
Some doctors recommend that all women who could have a baby take prenatal vitamins, even if they dont plan a pregnancy.
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How To Get Enough Folic Acid To Prevent Neural Tube Defects
In addition to eating foods with folate from a varied diet, women can get folic acid from
- Taking a vitamin that has folic acid in it:
- Most vitamins sold in the United States have the recommended daily amount of folic acid that women need for the prevention of neural tube defects. Vitamins can be found at most local pharmacy, grocery, or discount stores.
If taking folic acid for reasons other than neural tube defect prevention, talk to your healthcare provider.
How Do I Know If My Baby Has It
Most spina bifida can be detected by a combination of a blood test after 15 weeks into your pregnancy and an ultrasound of the spine and brain, typically between 18 and 20 weeks. Because some spina bifida can be associated with a genetic abnormality, the specialists discussing your babys findings may suggest an amniocentesis and a more detailed ultrasound and consult in a high-risk centre.
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Exposure To Drugs With Antifolate Activity
Women exposed to medications with antiâfolic acid action including antiepileptic drugs , sulfonamides, and methotrexate have shown an increased risk of NTD.
There is experimental evidence to show that higher doses of folic acid can prevent NTDs associated with in utero exposure to valproic acid., Moreover, for all antifolate antiepileptics a dose-response relationship has recently been documented between drug dose and adverse outcome, indirectly suggesting that higher doses of folic acid may be more effective in preventing NTDs. Although ethically it is not possible to randomize women to receive/not to receive folic acid at different doses for the purpose of showing prevention of NTD by higher vs regular doses of folic acid, it is logical to offer them higher doses of folic acid 2â3 months prior to conception and through the first trimester of pregnancy, as they may more effectively prevent NTDs.
Prenatal Vitamins With Folic Acid & Dha
Taking prenatal vitamins one month before conception can help a woman build reserves of folic acid, DHA and other important nutrients. Many manufacturers offer a traditional prenatal vitamins, plus a second pill or tablet that contains DHA. But the Prenate® Vitamin Familys line of prenatal vitamins offers four products with folic acid and DHA in a single dose, taken once daily.
Every Prenate® product meets or exceeds recommendations from the CDC for daily consumption of folic acid. Each contains 1 mg folate as a blend of bioavailable L-methylfolate and traditional folic acid. In addition, each contains a significant amount of marine-based DHA to help meet daily nutritional goals. Designed for the needs of both mothers and babies, the Prenate® Vitamin Family helps fill nutritional gaps. Talk to your doctor to see which prenatal vitamin with folic acid is right for you.
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Why You Need To Take Folic Acid
Folic acid is vital to the normal growth of your baby’s spine, brain and skull. Taking a daily vitamin supplement that has folic acid can reduce the risk of your baby having a neural tube defect.
The benefits of taking folic acid to reduce the risk of NTDs are highest in the very early weeks of pregnancy. At this stage, most women do not know they are pregnant. For this reason, taking folic acid before you become pregnant and in the early weeks of pregnancy is very important.
Its never too early to ask your health care provider about folic acid.
Whats The Difference Between Folic Acid And Folate
- Birth defects. Research has shown that folic acid supplements can prevent birth defects of the neural tube. Taking a daily prenatal vitamin ideally starting three months before conception can help ensure women get enough of this essential nutrient.
- Folic acid deficiency. Nutritional folate deficiency is treated with oral folic acid supplements. This type of deficiency is no longer a problem in many countries that fortify foods such as cereal and pasta with folic acid.
- Heart and blood vessel disease and stroke. Folic acid works with vitamins B-6 and B-12 to control high levels of homocysteine in the blood. Elevated homocysteine levels might increase your risk of diseases of the heart and blood vessels .
- Cancer. Some research suggests that folate might reduce the risk of various cancers.
- Depression. Some evidence suggests that folic acid might be helpful in treating depression.
- Dementia. There isnt enough evidence to support folic acid supplementation for the prevention of dementia.
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Can I Prevent My Baby Getting Spina Bifida
The best way to reduce the risk of your baby developing a neural tube defect is to take daily folic acid supplements from 12 weeks before conception until at least 12 weeks of pregnancy. Researach shows that taking a daily folic acid supplement of 400 micrograms reduces the risk of your baby developing spina bidifa and similar birth defects by up to 70%.
How Do I Prevent It
The incidence of spina bifida in Canada varies by province but is approximately 1/1000 pregnancies. The best way to protect your baby is to start taking folic acid at least 3 months before you get pregnant. This will decrease the chance of your baby developing spina bifida by about 50%. If you wait until you get pregnant or miss your period to start folic acid supplements, you are too late. The spine forms like an open book and it closes around 42 days from the first day of your last menstrual period, which is approximately 28 days after you ovulate or 14 days after you have missed a period.
You only need to take a daily dose of 400 µg, though most vitamin supplements contain 1000 µg . Women who have diabetes or are taking certain epilepsy medications, women who have previously had a baby with spina bifida and women who are obese need to take higher doses of folic acid ask your health care provider what is right for you.
Because almost half of all pregnancies are unplanned and unfortunately, many women are not on folic acid when they get pregnant, Canada and many other countries around the world require fortification of grains and pastas to increase the intake of folic acid in the population. Since this was done in Canada in 1988, the incidence of spina bifida has decreased.
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Vast Majority Of Poor Urban Women Dont Use Prenatal Vitamins Before Pregnancy Study Shows
A study of urban mothers found that fewer than 5 percent of them started folic acid supplementation and used it almost daily before pregnancy
A report of the findings was published on April 19 in the American Journal of Public Health.
The findings are concerning because they show that public health interventions arent always effective in reaching vulnerable populations who need them the most, says Tina Cheng, M.D., M.P.H., co-director of Johns Hopkins Childrens Center and the studys lead author.
Numerous studies have shown that prepregnancy use of prenatal vitamins containing folic acid can prevent 50 to 70 percent of neural tube defects. Since 1992, the United States Public Health Service has recommended all women of reproductive age take folic acid supplementation.
Development of the neural tube is completed about 28 days postconception, Cheng notes, often before a womans aware she is pregnant, and because nearly half of all U.S. pregnancies are unintended, its important for all women of reproductive age to routinely take folic acid supplementation. Prenatal vitamin supplements sold over the counter cost about 30 cents a day.
To better understand the pattern of prenatal vitamin supplementation and the blood levels of folate in U.S. high-risk populations, Cheng and her colleagues focused on a group of 8,494 mother-infant pairs recruited into the Boston Birth Cohort between 1998 and June 2014 at the Boston Medical Center.
Not Getting Enough Folate
Because the body has a high demand for folate, women may not get enough of this nutrient during their childbearing years . Women who are at higher risk include those who:
- are not taking the recommended folic acid supplement,
- are on restricted diets ,
- have a lower socio-economic status, and
- are experiencing food insecurityFootnote 5.
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What Foods Contain Folic Acid
Folic acid is added to foods that are refined or processed :
- Breakfast cereals
- Breads and pasta
- White rice
Since 1998, the Food and Drug Administration has required food manufacturers to add folic acid to processed breads, cereals, flours, cornmeal, pastas, rice, and other grains.9 For other foods, check the Nutrition Facts label on the package to see if it has folic acid. The label will also tell you how much folic acid is in each serving. Sometimes, the label will say “folate” instead of folic acid.
Recommended Folate Intake During Pregnancy
Folate requirements increase during pregnancy. There is a dramatic acceleration in cell division and red blood cell development as the uterus enlarges, the placenta develops, maternal blood volume expands, and the fetus grows . The mother also transfers folate to the fetus . Evidence supports a RDA of 600 mcg DFEs per day to maintain normal folate status during pregnancy .
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Frequently Asked Questionsexpand All
Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Folic acid may help prevent major birth defects of the fetuss brain and spine called neural tube defects .
When you are pregnant you need 600 micrograms of folic acid each day. Because its hard to get this much folic acid from food alone, you should take a daily prenatal vitamin with at least 400 micrograms starting at least 1 month before pregnancy and during the first 12 weeks of pregnancy.
Women who have had a child with an NTD should take 4 milligrams of folic acid each day as a separate supplement at least 3 months before pregnancy and for the first 3 months of pregnancy. You and your ob-gyn or other obstetric care provider can discuss whether you need to supplement with more than 400 micrograms daily.
Iron is used by your body to make the extra blood that you and your fetus need during pregnancy. Women who are not pregnant need 18 mg of iron per day. Pregnant women need more, 27 mg per day. This increased amount is found in most prenatal vitamins.
Calcium is a mineral that builds your fetuss bones and teeth. Women who are age 18 or younger need 1,300 mg of calcium per day. Women who are 19 or older need 1,000 mg per day.
Give you energy
Supply energy for your fetuss development
Promote good vision
Are There Risks From Taking Folic Acid
Generally when taken orally, and at appropriate doses, folic acid is safe. If you take too much folic acid your body gets rid of any excess in your urine.
Some people may experience minor side effects from taking folic acid supplements such as:
- Bad taste in the mouth
Signs of an allergic reaction to folic acid include:
- Skin rash
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What Is Spina Bifida
Spina bifida is a neural tube birth defect that occurs when a babys spine and spinal cord dont form properly.
It is unclear what causes spina bifida but it can be linked to a combination of genetic and environmental risk factors, for example a family history of neural tube defects and folate deficiency.
Signs and symptoms of spina bifida vary by type and severity and can also differ per person.
Most spina bifida cases are detected with an ultrasound scan around 18 weeks of pregnancy.
What About Other Nutrients
There are other nutrients that may improve the health of your pregnancy. Your doctor can help you decide if you need to take supplements that include:Omega-3 fatty acids: These fats, which include DHA and EPA , come only from food sources such as fatty fish and nuts. Studies show omega-3s can lower your risk of preterm birth and of having a baby with low birth weight. If you dont eat much food thats rich in omega-3s, ask your health care provider if a supplement is right for you.
Choline: Although your body can make some choline on its own, you get most of it from food. Rich sources include beef, pork, chicken, fish, and eggs. Many pregnant women dont get enough choline, which the baby needs for healthy brain growth.
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Synthesis Of The Data
The general recommendation of folic acid supplementation at 0.4âmg/day of folic acid may be appropriate for healthy and normal-weight women without the risk factors detailed above, who sustain this intake for at least 6 months prior to conception. Prenatal vitamins typically containing 0.8â1âmg of folic acid will confer appropriate protection if used for at least 3â6 months.
The groups of women who may benefit from taking 4â5âmg/day of folic acid, either singly or as part of a prenatal vitamin regimen when planning pregnancy are listed in Table .
|1. Previous pregnancy with NTD|
|2. Close family member with NTD|
|4. Use of drugs with antifolate effects.|
|5. Genetic mutations in the folic acid metabolic pathway or folate receptors|
|6. Poorly controlled type 1 or type 2 diabetes mellitus|
|7. Poor compliance with folic acid supplementation|
|8. Smoking, passive or active|
|9. Use of oral contraceptives|
|10. Celiac and Crohn diseases|
Many of the proposed guidelines are reflected in the 2015 guidelines by the International Federation of Obstetrics and Gynecology published in January 2015, although FIGO acknowledges that there is a paucity of data on the effects of high-dose folic acid.