Folic acid deficiency in pregnancy
Pro Research Analysisby 
Searched over 200M research papers
Folic Acid Deficiency in Pregnancy: Implications and Recommendations
Importance of Folic Acid in Pregnancy
Folic acid, a B vitamin, is crucial for the formation of red blood cells and DNA synthesis, making it essential for the rapid cell division and growth that occurs during pregnancy. Adequate folic acid intake is particularly important in the early stages of pregnancy to prevent neural tube defects (NTDs) such as spina bifida1 5 7.
Consequences of Folic Acid Deficiency
Neural Tube Defects and Other Complications
The periconceptional use of folic acid supplements significantly reduces the risk of NTDs. However, folic acid deficiency can lead to other severe pregnancy complications, including preterm delivery, low birth weight, and fetal growth retardation1 7. Additionally, elevated maternal homocysteine levels due to folate deficiency are associated with increased risks of spontaneous abortion, placental abruption, and preeclampsia1.
Anemia and Hemorrhage
Folic acid deficiency is a leading cause of macrocytic anemia in pregnancy, characterized by the presence of large, immature red blood cells. This condition can lead to severe anemia and increase the risk of hemorrhage during delivery2 3 6. Megaloblastic anemia, a severe form of anemia due to folate deficiency, is also linked to third-trimester bleeding and abruptio placentae2 3.
Dietary Sources and Supplementation
Dietary Intake
Folic acid is naturally found in leafy vegetables, meats (especially liver and kidney), and peanuts. However, cooking these foods in large quantities of water can destroy up to 90% of their folate content2. Given the increased demands during pregnancy, dietary intake alone is often insufficient to meet the body's needs.
Supplementation Recommendations
Routine supplementation of folic acid is recommended for all pregnant women to prevent deficiency. The minimum daily requirement during pregnancy is estimated to be between 300-500 mcg, but due to various factors such as poor dietary intake and increased metabolic demands, a daily supplement of 400-800 mcg is generally advised2 4 7. In high-risk pregnancies, such as those with a history of NTDs, higher doses may be recommended7.
Special Considerations
Genetic Factors
Genetic polymorphisms, such as those in the MTHFR gene, can impair folate metabolism, making supplementation even more critical for some women. These genetic variations can affect the activation of folate, which is necessary for DNA methylation and proper cell function7.
Coexisting Deficiencies
In populations with high rates of vitamin B-12 deficiency, such as rural Nepal, the benefits of folic acid supplementation may be influenced by the concurrent status of other micronutrients. Vitamin B-12 deficiency, for instance, has been linked to increased insulin resistance in offspring, regardless of folic acid supplementation8 9.
Conclusion
Folic acid is vital for a healthy pregnancy, preventing neural tube defects and other complications. Given the high risk of deficiency due to increased demands and potential dietary insufficiencies, routine supplementation is essential. Pregnant women should aim for a daily intake of 400-800 mcg of folic acid, with higher doses for those at increased risk. Addressing folic acid deficiency through diet and supplements can significantly improve pregnancy outcomes and support fetal development.
Sources and full results
Most relevant research papers on this topic
Folic acid: influence on the outcome of pregnancy.
Folic acid supplements during pregnancy reduce the risk of neural tube defects and other poor pregnancy outcomes.
Highly CitedFolic acid deficiency in pregnancy. On the recognition, pathogenesis, consequences, and therapy of the deficiency state in human reproduction.
Folic acid deficiency in pregnancy is common and can lead to severe anemia and megaloblastic marrow changes, requiring daily supplementation during pregnancy.
Folic acid deficiency in pregnancy.
Folate deficiency is a common cause of macrocytic anemia in pregnancy and is associated with complications like placental abruption and third-trimester bleeding.
Highly CitedFolic acid requirements of Indian pregnant women.
Indian pregnant women require around 300 g of folic acid daily, but 500 g is recommended during the last 100 days of pregnancy due to irregular intake and poor storage.
RCTFolic Acid.
Folic acid is essential for the formation of red blood cells, nerve function, and DNA replication in all body cells.
Highly CitedFolic-acid deficiency in pregnancy. The pathogenesis of megaloblastic anaemia of pregnancy.
Folic acid deficiency during pregnancy is common and may contribute to megaloblastic anemia of pregnancy, with increased folic acid clearance from plasma in 70% of subjects and all patients with twin pregnancies.
Observational StudyHighly CitedFolic acid in pregnancy
Daily intake of 400 g of folic acid from fortified food and vitamin supplements during pregnancy can reduce the risk of neural tube defects by 50%.
Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal.
Maternal vitamin B-12 deficiency is associated with an increased risk of insulin resistance in offspring, but antenatal micronutrient supplementation showed no significant change in insulin resistance in school-aged offspring.
RCT
Large Human Trial
Very Rigorous JournalHighly CitedFolic acid and vitamin B12 deficiency in pregnancy and in the neonatal period.
The fetus, the neonate, and the pregnant woman have a greater requirement for folic acid and vitamin B12 and are more likely to suffer from a deficiency of these vitamins. This article reviews the source, requirement, absorption, and metabolism of these vitamins and discusses the problems attributed to their deficiency in pregnancy and in the neonatal period.
Highly CitedSupplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal.
Folic acid plus iron and zinc supplementation during pregnancy provides no additional benefit compared to folic acid alone.
RCTHighly Cited