Dr. Makewu Oluwaseun, a consultant obstetrician and gynaecologist at the Medical Art Centre, Maryland Lagos, said it is imperative for pregnant women to take folic acid to ensure healthy development of babies in early pregnancy, as it is important for cell growth, reproduction, and especially spine regeneration. It is a daily requirement for both women and men.
Oluwaseun explained that for women, folic acid must be taken at a particular state. This is because the body system can have excess folic acid, which is stored up, but by the time there is need for it, the body will remove from the excess that is stored up. During pregnancy, the demand is higher, so the body will deplete the store. Consequently, women need to keep on getting the daily requirement, which is why there is an emphasis on women taking supplements to prevent their stored folic acid from being depleted and to be able to supply required level, when the need arises.
“Folic acid is essential for brain development and function,” Dr. Oluwaseun said. Its deficiency in pregnant women would affect the foetus, as it is one of the basic micronutrient requirements for cell synthesis and development, especially neurological development.”
The brain is the centre that coordinates all activities in the body. So, it sends signals to different parts of the body for development, but when the brain is not well developed, it could lead to lack of development in other organs.
One major implication of folic acid deficiency on the nervous system is known as Neutral Tube Defect (NTD), where the brain, spinal cord or the covering of these organs has not developed properly.
According to Oluwaseun, spinal bifida is the most common NTD. It results from the failure of the spine to close properly during the first month of pregnancy. Children with spinal bifida have varying degrees of paralysis of their lower limbs “Some children can be confined to the wheelchair, whereas others have almost no symptoms at all. The condition can also cause bowel and bladder problems.
Babies born with anencephaly have underdeveloped brains and incomplete skulls. Most infants born with anencephaly do not survive more than a few hours after birth.”
Studies have shown that women who take folic acid supplements before conception and during the first trimester may reduce their risk of having children with neural tube defects by 72 to 100 percent.
Child development studies at the University of Maryland Medical Centre, USA, showed that taking prenatal folic acid supplements at the time of conception is associated with lower risk of autism. Other studies showed that taking folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at three years. And some researches suggest that a low folate level during pregnancy is associated with a higher risk of emotional problems in the offspring.
So, what is the daily requirement of folic acid?
‘’For women, folic acid daily requirement is between 300 and 400 micrograms (0.4 mg) per day,” Dr. Oluwaseun said. “Usually, the supplementary product that people buy is formulated as 5mg per day, but the system only takes about 10 per cent of the folic acid consumed. It helps in the production of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), the body’s genetic material. It is especially important, when cells and tissues are growing rapidly, such as in infancy, adolescence, and pregnancy. Folic acid also works closely with vitamin B12 to help make red blood cells and help iron work properly in the body.”
The World Health Organisation recommends that all pregnant women receive a standard dose of 30 to 60 mg iron and 400-μg folic acid, as soon as possible during gestation.
Women who are planning to become pregnant should ensure to get the recommended 400 mg per day since many NTD can happen shortly after conception and before a woman even knows she is pregnant. Prenatal vitamins contain the needed amount of folic acid for pregnant women. Ideally, women should receive iron-containing supplements no later than the first trimester of pregnancy, which means taking 180 tablets before delivery.
Oluwaseun said though Nigerians eat vegetables, but they still need to take folic acid supplements, as there are still so many cases of NTD in both private and government hospitals. This is attributed to some factors that affect the quality of vegetables consumed. These include the method of preparation, storage, and how the vegetables were harvested.
Dr. Oluwaseun explained that folic acid, sometimes called Foliate, is a B vitamin (B9) found mostly in dark, leafy green vegetables, such as broccoli, spinach, asparagus, peas, salmon, citrus, milk, avocado, white beans, kidney beans, whole grains, root vegetables, wheat germ, beef liver, chickpeas and brown rice. Other useful sources include fortified breakfast cereals, beans, some bread, oranges and bananas.
Food fortification also known as food enrichment is when nutrients are added to food at higher levels than what the original food provides. This is done to address micronutrient deficiencies across populations, countries and regions. WHO, Copenhagen Consensus, and the Food and the Agriculture Organisation, as one of the top four strategies for decreasing micronutrient malnutrition, have identified it.
Globally, 84 countries have legislation that mandates fortification of wheat flour, maize flour, or rice. Nigeria is one of them.
Prof. Mustapha A. Danesi, a consultant physician and neurologist at Lagos University Teaching Hospital, Idi-Araba, said: “We treat a lot of epileptic seizures and we prescribe a variety of medications. For a woman of child bearing age, it is virtually compulsory that when any anti epileptic medication is given, folic acid should also be included, from the age 13 until they are 55 years, whether pregnant or not. This is because in the past, when anti-epileptic medication was prescribed, the patients were seen to have developed NTD, as a result of the drug.”
“Studies have shown that people, who were already on folic acid, never had NTD. By the time a woman realises she is pregnant; it would probably be in the sixth or seventh week, when the neural tube is already formed. So, if there is going to be any defect, the damage had been done,” Prof. Danesi explained.