FOLIC ACID INFORMATION
Frequently Asked Questions
> What
is folic acid?
> What
is the current folic acid recommendation?
> What
do women know about folic acid?
What is folic acid?
| Folic acid (pteroylglutamic acid) is
a B vitamin that acts as a coenzyme in single-carbon
transfers. It is involved in many reactions, especially
those in cell division, including: |
- DNA synthesis as part of a coenzyme
for pyrimidine nucleotide synthesis
- Purine synthesis
- Generation and utilization of formate
- Amino acid conversations, most notably
the conversion of homocysteine to methionine
|
Folate is a generic term usually applied
to the natural form of folic acid found in food. Food folates
are pteroylpolyglutamates, which contain one to six additional
glutamates compared to folic acid. These polyglutamate derivatives
must be hydrolyzed to monoglutamate forms prior to absorption
in the proximal small intestine. Most women don't eat enough
folate. In addition, dietary folates are heat-liable, thus
easily destroyed by storage and cooking. It is estimated that
only 50% of dietary folate is bioavailable. Therefore,
dietary folate is insufficient protection against NTDs for
most individuals and the general population.
Only folic
acid supplementation, along with a healthy diet, has been
proven to reduce NTD risk.
This is true even when women are counseled about
increasing dietary folates. Folates are found in many foods,
but rarely in large amounts. The highest amounts are in
fortified breakfast cereals, liver, most dried beans and
peas, some green vegetables, and oranges.
Folic acid's role in the prevention of birth defects is
well documented and supported by the best scientific evidence.
This includes observational and randomized-control trials.
Recent research suggests that folic acid supplementation
may play a role in reducing the risk of other congenital
conditions such as orofacial clefts, conotruncal heart defects
and defects of the urinary tract. For adults, it may play
a role in reducing the risks for heart disease, stroke and
vascular diseases, poor cognitive function in the elderly
and colorectal cancer. Due to its ubiquitous role in coenzymes
and DNA synthesis, folic acid will continue to be a topic
of research.
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What
is the current recommendation?
The NC Folic Acid Council recommends that all women
of childbearing age should take
a multivitamin containing 400 micrograms of folic acid every
day and eat a healthy diet.
Some women need more folic acid. Women
who have had an NTD-affected pregnancy, have an NTD or are
a close relative of someone with an NTD
should consume 400 micrograms of folic acid every day when
not planning to conceive. When planning to conceive, they
should consult with their health care provider about taking
4000 micrograms (4 milligrams)
of folic acid daily beginning
one month before planning to conceive and continuing through
the first trimester. This recommendation is based on guidance
from the CDC, US Public Health Service and the Maternal-Fetal
Medicine Committee of the American College of Obstetricians
and Gynecologists. Taking
this higher dosage should only be done under doctor's supervision,
because it could mask the signs of pernicious anemia.
| Because the evidence of folic acid's
role in preventing birth defects is so strong, the following
government, health and non-profit organizations recommend
that women take 400 micrograms folic acid daily: |
|
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What do women
know about folic acid?
According to data obtained through the North Carolina Pregnancy
Risk Assessment Monitoring System (PRAMS) survey, many women
still don't know about folic acid, what it does or that
it should be taken before pregnancy. PRAMS is an on-going,
population-based, randomized survey of North Carolina resident
women who have recently given birth. It is conducted by
the NC Center for Health Statistics.
| Recent PRAMS results show that: |
- 23% of women have never heard of
folic acid
- 74% do not take a multivitamin with
folic acid
- About 60% do not know that folic
acid can help prevent birth defects
- Around 90% do not know that folic
acid should be taken before pregnancy
- Health care providers along with
materials obtained from health care provider offices
were the major sources of information about folic
acid
|
A
recent national survey conducted by the Gallup Organization
for the March of Dimes demonstrated that when women were told
why a multivitamin with 400 micrograms of folic acid is recommended,
66% were "very willing" and 22% were "somewhat
willing" to buy and take the supplement.
Talk to your
patients about a multivitamin. Your advice makes a big difference.
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