Folic acid is important for all women during pregnancy
The proof is scientific: this nutrient protects children against neural tube diseases such as spina bifida.
During pregnancy, women need a more balanced diet rich in nutrients. Vitamins, minerals and proteins help maintain the mother's health and also the development of a healthy baby. Among the many allies in this special time of life is folic acid.
"Folic acid is extremely important for preventing birth defects, especially neural tube defects, and plays an important role in preventing anemia in pregnant women. Folate is involved in many cellular reactions, especially in developing organs. Several studies have shown that it prevents possible congenital diseases, including heart disease and autism," explains Dr. Renato de Sá.
The indication of folic acid supplementation is a guideline of several important global health organizations, including the US Department of Health and Human Services' Federal Agency (FDA) and the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo). This indication is supported by several studies over the years, which prove that this nutrient acts positively for women during pregnancy.
Information from non-scientific sources, however, can confuse the population. It is not true, for example, that women with a polymorphism (of MTHFR) - a condition that causes difficulty in absorbing folic acid - should use another option for the nutrient: methylfolate. With the recommended doses of folic acid supplementation (400mcg/day) they can achieve the same level of protection as the general population.
"No medical society in the world recommends methylfolate for pregnant women. Having the impression that a certain component works in pharmacological terms does not mean that it is actually effective in a real biological situation. In addition, there is no study that proves the prevention of neural tube defects with this component. That's why societies don't endorse it. We know that folic acid in the correct dosage works. We have the confidence to say this because it has been tested and approved by studies of great scientific value. It doesn't make sense to use an untested and unproven medication," says the doctor.
Dr. Renato de Sá draws attention to the correct dosage of folic acid, which is 400 micrograms. "This dosage is not random. It's a recommendation from the World Health Organization (WHO) regarding the ideal dose of folic acid to be consumed daily by pregnant women, which involves three components: food intake, another that may or may not be present in the fortification of flours and a percentage related to the supplementation that women should take. When we do this analysis, 400 micrograms represents the ideal dose to reach the WHO recommended daily intake. Above that, it has not been properly tested and below that the risks of birth defects increase. If more supplementation is needed, the doctor will recommend it, for example, a woman who has had bariatric surgery who may need a higher dose or women who have previously had children with neural tube diseases - these do need a higher dose of folic acid supplementation when they want to get pregnant again. But the recommendation for the general population is to use 400 micrograms," concludes the specialist.
400 mcg of folic acid should be taken at least 30 days before conception and in the first trimester of pregnancy. That's why all women should use it, regardless of the variants (MTHFR polymorphism) that may exist. After all, there is the confidence and security of years of results, as well as scientific backing.
Neural tube defects (NTDs)
Most of the problems caused by NTDs result in lesions in the brain or spinal cord. These are congenital malformations, which directly influence the infant mortality rate and children's health. Failure of the neural tube to close can result in anencephaly (when brain tissue doesn't develop) and spina bifida - when the bones of the spine don't close properly.
* Information extracted from the DTN-Fol Webinar by interview with Dr. Renato de Sá.
With the theme: THE MYTH OF MTHFR CHANGE IN DFTN PREVENTION. Main evidence and recommendations from Brazil and the world. Held on February 4, 2021.
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