Folic Acid Supplementation in Pregnancy for Prevention of Neural Tube

Folic Acid is an important supplement for reproduction.  Folic acid plays a key role in the formation of nucleic acids (the building bloods of DNA).  Folic acid is a necessary component form normal formation of the neural tube (the structure that eventually becomes the brain and spinal cord).  The nural tube form quickly with rapid cell division and growth that requires folic acid stores to be adequate for the production of DNA and tissue development.   The neural tube develops from weeks 4-6 of pregnancy, as a result it is recommended that folic acid supplementation prior to conception is needed  to build-up stores in the body.  This allows from proper embryo development and prevents congenital conditions such as spina bifida (incomplete closure of the neural tube which leads to severe morbidity and mortality of the fetus or neonate).

Current recommendations are for 0.4 – 0.8mg (can also be written as 400mcg or 800mcg), starting 4-6 weeks prior to conception.  Patients who have certain medical conditions or a history of spina bifida are often placed on higher levels of folic acid (4-5mg).  Very high doses of folic acid have been associated with childhood cancer risk, however no detrimental associations have been observed for the standard 0.4-0.8mg dose.

Certain patients who have specific mutation in the MTHFR gene, as well as patients with high stores of folic acid in their tissue may benefit from using a different form of folate called 5-methyltetrahydrafolate.  However further research needs to be done to determine clinical significance.  There does not appear to be any detriment to using 5-methyltetrahydrofolate for supplementation when compares to folic acid.