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Folic Acid, Multivitamins and Pregnancy

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Folic Acid and Prenatal Vitamins

 

Some newborns come into the world with serious birth defects. In Canada, up to 50% of such defects could be prevented if women of childbearing had enough folic acid (vitamin B9) in their systems before and during pregnancy.

It is possible to prevent certain birth defects by taking multivitamins with folic acid before and during pregnancy.

Increased nutritional requirements and multivitamins during pregnancy

Pregnancy requires mothers to increase their nutritional intake in order to support their baby’s rapid growth and development. Meeting nutritional requirements before conception decreases the risk of preventable birth defects. It is often difficult for many women to meet the higher demand for vitamins and minerals with diet alone. Multivitamin supplements can help women planning to get pregnant, or those who already are, to meet recommended levels for the well-being and healthy development of their baby.

 

Neural tube defects (NTDs)

A sufficient level of folic acid in the blood is necessary at the time of conception and during the first trimester of pregnancy to reduce the risk of NTDs.

NTDs are severe birth defects that occur when the neural tube fails to close properly during the third and fourth week of pregnancy. This results in abnormalities of the spine, brain or skull that can lead to stillbirth, or severe disabilities such as spina bifida (the spine or its envelope bulges out of the back), anencephaly (absence of part of the brain), or encephalocele (part of the brain develops outside of the skull).

 

Am I at risk? 

The level of NTDs varies by region in Canada, and certain women have a higher risk of having a baby with neural tube defects. In most cases, they:

  • previously had a child with an NTD
  • have a family history of ATN
  • had maternal diabetes and/or insulin-dependent diabetes
  • suffer from epilepsy and take medication to control seizures
  • take medication known to interact with folic acid such as metformin or methotrexate
  • are Celtic, Sikh or come from Northern China
  • are obese with a body mass index > 35 kg/m2  (not sure anyone understands this)
  • use recreational drugs, smoke or drink excessively
  • has a malabsorption condition (e.g., Crohn’s disease)

 

Role of folic acid before and during pregnancy

Folic acid plays a key role in the production and maintenance of new cells, which makes it essential during pregnancy with its associated rapid cell division and growth. Folic acid with, or as part of, a prenatal multivitamin supplement has been proven to decrease the occurrence of specific birth defects such as neural tube defects (NTDs), heart defects, urinary tract abnormalities, orofacial clefts with or without cleft palate, limb defects, hydrocephalus as well as some pediatric cancers.

 

Sources of folic acid in food

Women are advised to maintain a healthy diet by following the recommendations in the publication Eating Well with Canada’s Food Guide. Some of the foods that are considered excellent to good sources of folic acid are:

  • Fortified grains
  • Spinach
  • Lentil
  • Chickpeas
  • Asparagus
  • Broccoli
  • Peas
  • Brussels sprouts
  • Corn
  • Oranges

As well, since 1998 in Canada, flour has been fortified with folic acid, which has reduced NTDs by 46%.

Women can maintain an adequate level of folic acid in their blood by adapting their diet and by taking a daily supplement of folic acid, which only 15 to 20% of women who become pregnant do. Since 50% of pregnancies are unplanned and, therefore, no supplements are taken, it is important to raise awareness of the importance of folic acid and the crucial role it plays in preventing birth defects such as NTDs. Taken on a daily basis, an appropriate amount of folic acid, with, or as part of a prenatal vitamin supplement, will not eliminate all birth defects, but will considerably reduce the risk of NTDs.

How much folic acid should a multivitamin contain?

Taking a vitamin and mineral supplement does not eliminate the importance of a balanced diet adapted to the special needs of pregnancy. Women in their childbearing years should discuss with their doctor, pharmacist or other health care professional which multivitamin provide the most appropriate amount of vitamins and minerals based on their medical needs, diet and stage of pregnancy.

Can you take too much folic acid?

The risk of toxicity from excessive folic acid intake from diet and supplements is low. Any excess folic acid will be excreted in the urine. However, if a higher dose of folic acid is necessary, you should discuss your choice of a supplement with a doctor, pharmacist or other health care professional. 

 

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