Why and when to start taking folic acid for pregnancy

Folic acid is a water-soluble B vitamin also called vitamin B9. It is introduced with food. Foods rich in folate are green leafy vegetables (spinach, broccoli, asparagus, lettuce), legumes (beans, peas), fruit (kiwi, strawberries and oranges) and dried fruit (such as almonds and walnuts). This vitamin plays a fundamental role in our body, but it acquires an even more important role in the preconception period. In fact, folic acid plays a particularly important role in the processes of cell proliferation and differentiation, as in the case of embryonic tissues, representing a sort of "fuel" for differentiation processes. Solid scientific evidence highlights the importance of taking folic acid before conception (in quantities from a minimum of 0.5 mg to 5 mg) especially to reduce the risk of neural tube defects, such as serious malformations of the central nervous system such as spina bifida, encephalocele and anencephaly.

Folic acid is also a protective factor against other malformations such as, for example, heart or bone malformations. If taken correctly in the preconception period, it can reduce the frequency of these malformations by 50 to 70%.

This fundamental role played by folic acid has also been confirmed by studying the specific case of the United States and Canada. In these countries, the folic acid content of cereals has been increased, resulting in a higher intake of vitamin B9 not only by women seeking pregnancy, but also by the entire population. Thanks to this intervention, it was possible to reduce serious malformations by 20-30%.

In this context, preconception counseling is of fundamental importance, which is a powerful means of primary prevention. Unfortunately, the risk of malformations is a natural risk: considering one hundred pregnancies, about five of these will present fetal malformations and of the latter 7-10% are linked to teratogenic factors. With preconception counseling it is possible to act on some factors and with folic acid supplementation to reduce the incidence of fetal malformations. It is good to start vitamin B9 supplementation about two to three months before the presumed conception because, when the woman realizes that pregnancy has begun, it is usually around the sixth or seventh gestational week and by this time the neural tube of the unborn child will have already formed. Therefore, if the woman starts taking folic acid from this moment, this intervention will not be helpful. Unfortunately, only with food, even if rich in fruit and vegetables, it is not possible to guarantee the minimum useful dose of 0.4 mg of folic acid: it is, therefore, necessary to supplement, even for months, to reach the effective dosage.