Taking folic acid before pregnancy and for the first three months of pregnancy can reduce your chances of having a baby with spina bifida or problems with the development of the brain (called neural tube defects).
* Spina bifida is where the spinal cord, and the bones, muscle and skin that cover it, do not form normally. Have a look at the information about spina bifida below. * The abnormal development occurs when the spinal cord and brain are forming during the sixth week of pregnancy (4 weeks after conception). This is often before a woman knows that she is pregnant.
Why take folic acid?
Research has shown that the chance of having a baby with spina bifida is much less if a woman increases her intake of folic acid for at least one month before she gets pregnant and for the first three months of her pregnancy.
* Every woman who could become pregnant should be sure she gets enough folate and this is best done by taking folic acid tablets. * The risk is much lower, but taking extra folic acid does not totally eliminate the risk.
Taking folic acid before pregnancy may also lower the risk of some other heart, kidney and limb abnormalities. The evidence for this is not as strong as for spina bifida, and more research is being done.
There is no evidence that other vitamins or minerals will protect your baby against spina bifida.
What is folate or folic acid?
* Folic acid is a water-soluble B-group vitamin that is needed for healthy growth and development. The vitamin is known as 'folate' when it is found naturally in food, and 'folic acid' when it is added to foods or when it is in tablets. Folic acid is turned into folate in the body. * It can be found naturally in most plant foods, especially green vegetables, wholegrain breads and cereals, peas and dried beans. * Extra folic acid is also added to some foods, such as some breakfast cereals, some breads and fruit juices. If folic acid is added, this will be marked on the labelling.
How can you increase your folic acid?
* The easiest and most effective way is by taking a daily folic acid tablet. A healthy diet is important, but it is very difficult to get enough folate from foods to prevent spina bifida. * Folic acid tablets are quite safe to take. The tablets recommended are 0.5 milligrams (which is 500 micrograms). One tablet each day is enough. (Note: tablets in other countries may contain a different amount of folic acid.) * Folic acid tablets are available from chemist shops (without a prescription), health food shops and some supermarkets. * Some multivitamins contain folic acid, but often at a lower dose, so it is best to take the separate tablets.
Who should take folic acid tablets?
* Folic acid works best if it is taken for at least one month before starting a pregnancy. * As many pregnancies are unplanned, it is recommended that all women of child bearing age who could become pregnant, take a folic acid tablet (0.5 milligrams) every day. * If you have a family history of spina bifida, or take medication for epilepsy, you may need a higher dose of folic acid. Ask your doctor about this. * Extra folate is not as effective if you start to take it after you know you are pregnant but it is worth taking it if you suspect you may be pregnant (for example if you have missed a period). * The risk of having a baby with spina bifida if extra folic acid was not taken is still small.
What is spina bifida?
Spina bifida is a serious abnormality of the spinal cord and the bones, muscles and skin covering it. 'Spina' means spine, and 'bifida' means divided or split.
* Babies with spina bifida usually have an obvious abnormality on their back when they are born. Some will die soon after birth and most need a lot of treatment. * Spina bifida can cause permanently weak legs, no feeling in the legs and problems walking. Many people with spina bifida will need to use a wheelchair. * There can also be problems with bladder and bowel control. * Other neural tube defects affect the development of the brain as well as the spinal cord. * There is no cure for spina bifida.
For more information about spina bifida, have a look at the site of the Spina Bifida and Hydrocephalus Association of South Australia http://www.spinabifida.asn.au/
What is the risk of spina bifida?
* Any woman could have a baby with spina bifida or other neural tube defect. * About 1.2 in 1,000 babies in South Australia is born with a neural tube defect. * The risk is higher if another family member has had spina bifida. You can have tests to check for neural tube defects during pregnancy. * Taking folate for at least 1 month before getting pregnant and during the first 3 months has been shown to reduce the risk by up to 70%.
Finding out whether an unborn baby has spina bifida
* Most women in Australia have an ultrasound examination during early to mid pregnancy. Most babies with spina bifida will be found by that ultrasound. * Blood tests which find most neural tube defects may also be done.
Mandatory folic acid fortification in Australia
Mandatory fortification is where food manufacturers are required to add a vitamin or mineral to a food. These are added in response to a significant public health need. Mandatory folic acid fortification requires Australian millers to add folic acid to wheat flour for bread-making purposes. This will mean most bread in Australia will contain folic acid.
Most women of child-bearing age are not consuming enough folic acid even though they are advised to take folic acid tablets. Food Standards Australia New Zealand (FSANZ) is introducing mandatory folic acid fortification to provide additional protection for babies.
FSANZ has allowed industry two years to prepare to add folic acid to wheat flour used in making bread. Wheat flour will contain folic acid by 13 September 2009.
Bread made with wheat flour will contain folic acid under mandatory fortification.
* This includes all plain, fancy and sweet breads and rolls, bagels, foccacia, English muffins and flat breads (containing yeast). * Other products that might be made with ‘wheat flour for making bread’ include crumpets, scones, pancakes, pikelets, crepes, yeast donuts, pizza bases and crumbed products. * Flour mixes for domestic bread-making will also contain folic acid; however it will not be a requirement for other types of packaged domestic flour. * Organic bread will not be required to contain folic acid. * Bread made from other cereal grains such as rice, corn and rye, provided they do not contain any wheat flour, do not have to contain folic acid. However, manufacturers may add folic acid if they wish.
Some manufacturers also choose to fortify other foods with folic acid, including breakfast cereal, yeast spread and fruit juice (voluntary fortification). They will still be able to do this.