The Importance of Folic Acid in Pregnancy: A Public Health Perspective

This report delves into the critical role of folic acid during pregnancy, emphasizing its significance in preventing neural tube defects, such as spina bifida, and ensuring healthy fetal development. It explores the mechanisms by which folic acid supports the formation of the brain and spinal cord, particularly during the early stages of pregnancy. The report highlights the recommended daily intake of folic acid, the importance of supplementation before and during pregnancy, and the consequences of folate deficiency, including an increased risk of neural tube defects. It also discusses the sources of folic acid, including both dietary and supplemental forms, and the public health initiatives aimed at increasing folic acid intake among women of childbearing age. The report underscores the need for adequate folic acid consumption through supplements and dietary modifications to achieve optimal maternal and fetal health outcomes. The report also includes the metabolism of folic acid in the body and the impact of folic acid fortification strategies on the reduction of neural tube defects.

Folic Acid and Pregnancy
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Epidemiological studies have demonstrated that the
need for management of inter-uterine environment
during the early fetal development.1 There has been
an increased level of understanding on the
mechanism underlying the DNA methylation
which entails the detailed functioning of the
epigenetic mechanism which is essential for
embryogenesis and adulthood in general. 2 Folic
acid has been attributed as a fundamental aspect
and of key attention due to its role on the
mediations of clinical outcomes. Folic acid is
essential during the pregnancy period due to its
role in the prevention of neural birth defects
associated with spinal cord such as the spina bifida
occurrences and brain deformation occurring on
the infants. 3
The original source of folate has been linked to the
endogenous substance occurring in the form of
vitamins and occurs naturally in food and synthetic
forms inform of supplements and fortified foods
products. Derivatives of folate are essential as they
lead to synthesis inform of nucleic acids, amino
acids, cell division and tissue growth and DNA
methylation.
Developmental effects associated with spinal and
brain is linked to the action of folic acid. The
occurrence of spina bifida is associated with failure
of the spinal column to close efficiently. Women
with spina bifida experience various disabilities
such as paralysis of the legs, p[problems associated
to bladder and bladder functioning.4 Folic acid is
essential on the proper development and the neural
tube process which is linked to the overall maturity
of the spinal and brain development among infants.
These developments of these organs normally
occur during the third and fourth week of
pregnancy, there is a need for adequate
consumption of folic acid prior to the conception of
pregnancy. Neural tube defects are often resulting
due to multifactorial disorders in the neuralation of
the spinal and brain parts of the body occurring
during the first 2 and 28 days of conception.5
Folic acid is essential as one-carbon metabolism
which is essential in the cellular reaction process.
These entail metabolism of amino acid,
biosynthesis of pyrimidine and purine and
formation of methylated agent S-adenosyl-
methionine associated with methyl donor for DNA
synthesis, lipids, and proteins.6
Women tend to require increased amounts of folic
acid during pregnancy to meet their nutritional
needs. Inadequate intake leads to other serious
complication on the infants. Currently, deficiency
of folate has been managed by supplementation of
folic acid intake of between 400 – 1000 μg per day.
This recommendation has been successful in the
overall management of tissue replenishment even
in instances of malabsorption cases. 7
Diagnosis of megaloblastic anemia needs to be
often be tested for vitamin B12 deficiency before
management. Supplementation of folic acid is able
to remove anemia however can worsen other
neurologic problems.8
The occurrence of bioavailability of folic acid
supplementation and folate forms found in food,
the dietary folate equivalent has been implemented
with the recommendation
Inadequate intake of folate acid has been
associated with unhealthy diets occasioned by a
limited intake of adequate vegetables and folate-
rich foods. Future genetic factors have been
associated with lowered levels of folate and certain
medication intakes such as the phenytoin and
sulfasalazine. Moreover, its deficiency has been
linked to increased alcohol intake with interferes
with the transport of folate. 8
Inadequate levels of folate are linked to glossitis,
depression, confusion, fetal neural tube defects,
and brain formation. Diagnosis of folate levels is
attributed to complete blood count and levels of
plasma vitamin b 12 and the levels of folate.
Incidences of μg/L or lower level indicate a
deficiency of folate. The levels of folate reflect the
state of the folate status with the status of
erythrocyte levels indicating better stores of folate
intake. Folate stores of below 140 μg/L signify
Introduction
Role of Folic during pregnancy
Inadequate intake
Folic Acid Intake During Pregnancy Phase

lowered levels of folate stores. 9
Over the previous year’s studies have highlighted
community-based initiatives to manage the peri-
conception supplementation of folic acid as it leads
to lower occurrence of neural tube defects among
neonates.10 Normal folic acid intake is absorbed in
the intestines and liver and, metabolism occurs due
to 5 methyl tetrahydrofolate and effect of
polyglutamate for retention of cells as observed
from figure 1 below;
The metabolism of folic acid is often modulated in
various ways through various enzymes and
coenzymes acting on the modulating effect through
the donation of carbon units.
Folic acid fortification strategies have often
involved public health strategies on flour
formulation through the increase of folic acid
levels in the population. Many health and
government organizations have implemented folic
acid supplementation for women. Folic acid is
beneficial during the first four weeks of pregnancy
and before many women release, they are pregnant.
Implementation of mandatory supplementation has
been rolled in various countries. 11
A meta-analysis of the global prevalence of spina
bifida has shown that after food fortification has
been implemented has seen a reduction by at least
30% reduction of live births linked to spina bifida
(Atta 2016). 12
In Australia Folic acid supplementation has been
undertaken with flour fortification through the
Food Standards Australia New Zealand initiated in
2007. The required recommendations have been set
at 135 μg of folate per 100g of bread.
Folic acid is crucial during the development
process, especially during the neurodevelopment. It
ensures that there is a complete closure of the
neural tube in the uterus wall. This is the initial
step in embryo development and forming the brain
and spinal cord, failure of this closure leads to the
development of neural tube defects, thus this
informal the key role during pregnancy period.
Inadequate intake has tremendous effects on
overall fetal development during the pregnancy
period. Appropriate intake of folic acid
supplements and dietary modification is essential
for the overall pregnancy period.
Due to the neonatal benefits of folic acid during
pregnancy, there is a need to ensure that there is
100% daily value absorption in the body.
Appropriate avenue is the intake of vitamin
supplementation. Intake of pills is essential as it
has 100 % daily value thus enhancing its
bioavailability in the body. Other avenues entail
multivitamin intake or using single supplements of
folic acid.
Intake of a brand multivitamin is essential as it has
the right amount of folic acid which has the ability
to improve body stores. Dietary modification of
folic acid is highly recommended. Inclusion of
breakfast cereals is essential as it improves the
folic acid store in the body.
The daily recommended levels are advised for all
women of childbearing age is 400 mcg daily. The
intake based on various stages of pregnancy entails
400 mcg during initial trails of conception, 400
mcg for the first 3 months of pregnancy, four to
nine pregnancy months increased levels of 600
mcg while during breastfeeding intake of 500 mcg
is recommended.
Supplementation strategies
Conclusion
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