Role of Folic Acid in Women's Health

Folic acid is a synthetic version of folate (B9 vitamin), especially important for women during pregnancy. It is a water-soluble and essential micronutrient used by our bodies to create new cells and is vital for the proper functioning of the body. Some body cells are continuously rejuvenating, like the red blood cells and cells lining our gut tube. Folic acid is necessary for their growth and maturation.  

Folate Deficiency and Associated Conditions

Folate deficiency occurs when the body lacks an adequate amount of folic acid resulting in a type of anemia known as megaloblastic anemia. Folate deficiency may also increase the risk of congenital abnormalities during pregnancy. The most prominent symptoms of folate deficiency include:

● Weakness

● Fatigue

● Difficulty concentrating

● Irritability

● Headache

● Sores on the tongue and inside the oral cavity 

● Changes in skin, hair, or fingernail color

● Shortness of breath

● Heart palpitations

The following groups are at a higher risk of folate deficiency:

● People suffering from alcohol abuse disorders

● Women of childbearing age

● People suffering from nutrient absorption disorders such as irritable bowel syndrome (IBS) and celiac disease

● People with MTHFR polymorphism (a genetic condition impairing the ability to convert folate to its active form and resulting in elevated blood levels of amino acid homocysteine) 

Role of folic acid during pregnancy

Folic acid is vital for prenatal health and during pregnancy. Doctors and healthcare facilitators recommend folic acid during the early stages of pregnancy as it aids in the formation of the neural tube of the fetus that is responsible for forming the early brain and spine. Thus, suitable intake of folic acid during pregnancy can help prevent severe congenital disabilities associated with the baby's brain (anencephaly) and spine (spina bifida). Folic acid may also lower the chances of premature birth, heart irregularities, and cleft palate in newborns. 

Because the number of unplanned pregnancies is increasing rapidly, and significant congenital disabilities of the brain and spine occur very early in pregnancy (3-4 weeks post conception), it is advised that all women of reproductive age must have 400 micrograms (mcg) of folic acid every day to fulfill folic acid requirements and help prevent some congenital disabilities. The doctor may recommend a higher dose of folic acid than 400 mcg per day depending upon the health and clinical conditions of the individual:

• Women planning for a pregnancy should take 400-800 micrograms (mcg) of folic acid or L-5-Methyltetrahydrofolate, the natural form of dietary folate, per day. 

• Those breastfeeding should aim for 500 mcg per day.

• Some women may require high doses of folic acid (1,000 mcg per day), especially with a family history of sickle cell disease, inflammatory bowel disease (IBD), celiac disease, or malabsorption problems. 

• Women with a family history of neural tube abnormalities are recommended 4,000 mcg of folic acid per day. 

It is advisable that very high doses of folic acid should be taken only under medical supervision.

 
Sources and Dietary Requirements of Folic Acid

Folic acid is widely found in various dietary supplements and fortified foods such as cereals, bread, flour, and grains. It's also a common ingredient in B-complex vitamins. Many foods also contain naturally high levels of folate. However, the body more readily absorbs folic acid from supplements and fortified foods than folate from naturally occurring foods. The natural sources of folic acid include:

Folic acid need for women varies with age, general health and clinical conditions. The Office of Dietary Supplements has recommended the dietary requirements of folic acid for the women of different age groups:

Side Effects of Folic Acid

Folic acid is considered a safe dietary supplement and many medical professionals have agreed that even the excessive intake of folic acid does not pose any serious side effects on the individual's overall health. However, some people might report an upset stomach in extremely rare cases. On the contrary, some studies have evidenced that having too much unmetabolized folic acid in the blood is linked to certain types of cancer and conditions such as anemia or insulin resistance.

The Bottom Line

Folic acid is a type of B vitamin that is particularly important for pregnant women. It plays a vital role in the formation of the neural tube, which becomes the brain and spine of the fetus. Adequate intake of folic acid can help prevent various congenital disabilities, such as anencephaly and spina bifida. All women who are or may become pregnant should aim to consume 400-800 micrograms of folic acid or L-5-Methyltetrahydrofolate daily. Folic acid can also reduce the risk of premature birth, heart abnormalities, and cleft palate. It is found in dietary supplements, fortified foods, and B-complex vitamins and can also be obtained from natural sources such as liver, spinach, and peas.