The Importance of Folate During Fetal Development

Folate is known to prevent neural tube birth defects, which affect approximately 3,000 pregnancies every year in the United States [1].  This is an essential nutrient that supports neural tube development during pregnancy.

What Are Neural Tube Defects?

An embryo’s nervous system forms just one month after conception, before many women even realize they’re pregnant. Neural tube defects are birth defects of the embryo’s nervous system, which includes the brain, spine, and spinal cord. When an embryo is forming, the neural tube begins like a flat ribbon that rolls up lengthwise to form a tube that becomes the brain and spinal cord. The “seam” on the neural tube is completely sealed by 28 days after conception.  If that seam doesn’t close properly, portions of the spine, the spinal cord, or the spinal cord covering pushes outside of the fetus’ back as the fetus grows [2]. Spina bifida and anencephaly are the two most common neural tube defects that occur when the neural tube doesn’t close properly.
  • Spina Bifida

Spina bifida literally means “split spine” and is the most common neural tube defect. There are approximately 166,000 people in the United States living with spina bifida, according to the Centers for Disease Control and Prevention (CDC). You might be familiar with people who have spina bifida and need to use wheelchairs or walkers. But spina bifida ranges from mild to severe. People may not be aware they have spina bifida when it’s a mild form. The most severe forms are similar to a spinal cord injury causing paralysis and requiring multiple neurological surgeries [3].
  • Anencephaly

Anencephaly is a neural tube defect that affects approximately one in every 5,000 births and is always fatal. Infants born with anencephaly are missing some or all of their brains and skulls. Because of this, 75% of the time, they are tragically stillborn. In other cases, they only live a short time of hours, days, or weeks after their birth [4].

What Is Folate?

Folate, also known as Vitamin B-9, is an essential, water-soluble B-vitamin. An essential vitamin means that your body needs it to function correctly, but it can’t make the vitamin on its own, so you need to consume it through your diet or supplements. A water-soluble vitamin is one that your body doesn’t store, so you need to replenish it in your daily diet. You may have heard about the importance of folic acid or heard the terms folate and folic acid used interchangeably. But folate and folic acid are different. Folate is found naturally in foods such as leafy green vegetables, some fruits, and beans. Folic acid is the synthetic, oxidized form of the vitamin found in supplements and fortified foods [5].

Benefits of Folate

Folate is an essential vitamin and has a wide range of benefits for your body to function optimally [6]. Folate helps:
  • convert carbohydrates into energy
  • produce DNA, RNA, and other genetic material
  • cell division
  • produce red and white blood cells in your bone marrow
  • your body use fats and proteins
  • keep your liver, skin, hair, and eyes healthy
  • reduce your risk of heart disease, cancer, stroke, and Alzheimer’s Disease
  • proper function of your nervous system and brain
  • improve mental and emotional health
  • reduce the risk of neural tube defects in early pregnancy
As you can see, folate is a critical vitamin for your health. When you don’t get enough folate, you have a higher risk of heart disease, depression, certain cancers, and more.

The Importance of Folate During Fetal Development

Adequate folate is critical before and during pregnancy for healthy fetal development. Women who don’t get enough folate during pregnancy are at higher risk of neural tube birth defects, including cleft palate, spina bifida, and brain damage. Getting adequate folate reduces these risks. Studies reveal that the risk of neural tube defects is reduced by 72-100% when women get enough folate before conception and during the first trimester of pregnancy. It may also reduce the risk of miscarriage. Other studies of child development reveal that adequate folate before and during pregnancy also reduces the risk of autism, speech and language delays, and emotional problems as children grow [6].

How Much Folate Do I Need?

Adults need DFE (micrograms of dietary folate equivalents) of folate daily. Pregnant and nursing women need additional amounts DFE. You need more folate during your pregnancy because your body is going through rapid rates of cellular and tissue growth for the development of the placenta and fetus. Please check with your doctor for the correct amount you need. It is important to note that up to 60% of women have a defect in their methylenetetrahydrofolate reductase (MTHFR) gene that doesn’t allow them to convert synthetic folic acid into the active methylfolate needed to absorb the vitamin. Because of this, most doctors recommend that pregnant women take folate from whole food sources and supplements that contain the natural form of active folate (methylfolate) instead of synthesized folic acid whenever possible. For more information on the difference between folic acid and methylated forms of folate, click here.

 How Do I Get Enough Folate?

The primary sources of folate are naturally occurring folate in foods, dietary supplements of folic acid, and folic acid-fortified foods. Folate is naturally present in many foods.
  • Leafy green vegetables (spinach, lettuce, broccoli, etc.)
  • Legumes (beans, lentils, peas)
  • Some fruits (bananas, melons, lemons)
Folic acid (a synthetic form of folate) can be found in fortified foods and vitamin supplements. Talk with your doctor about taking vitamin supplements that provide the active, or reduced, form of L-methylfolate (5-MTHF) to help ensure your body is getting the folate it needs. If you think you might be pregnant or know you are facing an unexpected pregnancy, Pregnancy Care Clinic is here for you to provide you the care you need to make an informed decision for your future. We’re open during the COVID-19 crisis, so contact us today for a confidential appointment. [1] Centers for Disease Control and Prevention. (2017, November 9). Folic Acid & Neural Tube Defects: Data & Statistics Retrieved on April 14, 2020 from https://www.cdc.gov/ncbddd/birthdefectscount/data.html [2] Johns Hopkins Medicine. (n.d.). Neural Tube Defects. Retrieved on April 14, 2020 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/neural-tube-defects [3] Spina Bifida Association. (n.d.). What is Spina Bifida? Retrieved on April 14, 2020 from https://www.spinabifidaassociation.org/what-is-spina-bifida/ [4] Cleveland Clinic. (2017, January 9). Anencephaly. Retrieved April 14, 2020 from https://my.clevelandclinic.org/health/diseases/15032-anencephaly [5] Dolin C, D, Deierlein A, L, Evans M, I: Folic Acid Supplementation to Prevent Recurrent Neural Tube Defects: 4 Milligrams Is Too Much. Fetal Diagn Ther 2018;44:161-165. doi: 10.1159/000491786 [6] Mount Sinai. (n.d.). Vitamin B9 (Folic Acid). Retrieved on April 15, 2020 from https://www.mountsinai.org/health-library/supplement/vitamin-b9-folic-acid