To think the NHS are giving women TTC the wrong advice?

[Lolloveswoody]

Im struggling to word this post because I don't want to seem alarmist but I also want to share the information because it could help others.

A close friend sadly lost her baby recently at 16 weeks gestation and one of the possible reasons she was given was not enough folic acid although she was taking the recommended dose. A little research has yielded the following information, none of which seems to be common knowledge as far as I'm aware.

Folic acid is actually a synthetic version of a vitamin called folate and it's this vitamin we need to protect again neural tube defects, assist in the healthy development of the placenta and boost our blood cell production. The synthetic version (folic acid) is metabolised in a different way to natural folate and is not always absorbed as effectively, it also doesn't cross into the placenta as efficiently. Basically natural folate is better and it is available as a supplement.

When you consider that folate deficiency is implicated in the causes of placental abruption, recurrent miscarriage and pre eclampsia it seems odd that it's folic acid that's routinely prescribed and in the pregnancy supplements we buy over the counter rather than natural folate supplements. The reason is basically money, folic acid is cheaper.

Having suffered recurrent miscarriage myself and seen the heartbreak my friend has just gone through I just think, at the very least, this information should be public knowledge. Ideally I would like to see natural folate replace folic acid as the recommended (and prescribed) supplement for all pregnancies but I suspect the NHS and those marketing OTC pregnancy supplements will, sadly, resist this for financial reasons.

Nonetheless, the more people know about it the more pressure can be brought to bear and the greater the chance that it may happen one day.

[NapQueen]

Isn't it just one of those things? Folic acid does x, natural stuff does X. X is better than x but x is good enough.

Coincidentally the two pregnancies I took Folic acid sufficiently resulting in surviving babies and the one I didn't take anywhere near the sufficient dose ended at 12weeks.

[Butterchunks]

Hmm, interesting. In what way is folic acid different to folate? What is the difference in the metabolic pathway (and where are you getting your information from)? Can you explain more about why synthetic is not as good as natural?

[Lolloveswoody]

Except sometimes it isn't 'good enough', what if the natural stuff massively reduced the 1 in 5 pregnancies which currently end in miscarriage? Isn't that worth a little extra money?

[Lolloveswoody]

Lots of studies out there, I can link some if you like but they're fairly easy to find if you're interested enough to look.

[MoonriseKingdom]

Changing the type of supplements may be a red herring. I think problems are more related to people not supplementing with folic acid early enough or in sufficient doses.

Ideally you need to start folic acid supplements at least a month before TTC. I think a lot start when they get a positive test which may be too late if there is existing deficiency. Also women with a BMI into the obese category are recommended to take much higher doses. Given that many areas you have no health care contact until your booking appointment well into the first trimester it is likely this is started much too late.

One option used in Canada which I would be in favour of is supplementing bread flour which will improve the general consumption of folic acid.

[LilQueenie]

have you noticed what robert winston recently said about ivf. It has a much lower success rate than led to believe and a majority of issues could be put right before ivf is even needed. There are lots of things the NHS will tell women that is not quite right. things such as continue drinking coffee it wont make any difference! It can make a difference. they change information all the time.

[Absofrigginlootly]

I would love to see some research links please.... Thinking about TTC in the not to distant future.... I've been taking a pre natal and breastfeeding supplement for years which contains folic acid (need to check dose and whether it's folate or FA)

[Out2pasture]

However new research is linking the use of folate/folic acid and autism.
www.m.webmd.com/baby/news/20160511/too-much-folic-acid-in-pregnancy-tied-to-raised-autism-risk-in-study

[QuackDuckQuack]

I don't think that the advice for who needs to take the much larger dose of folic acid is sufficiently publicised. I saw GP, MW and consultant all within 1st trimester and despite fitting in one of the categories, none of them suggested it.

[NovemberInDailyFailLand]

I've noticed a lack of information on supplements as well.

One thing I think hypothyroid women should know is that you should never take iodine with thyroxine! Yet almost all the usual pregnancy supplements contain it. It can give false high readings on tests, causing women to reduce their thyroid medication, and this can result in mc.

[Absofrigginlootly]

out2 that link cites research contradicting itself all the way through and stresses that women should keep taking supplements

[MoonriseKingdom]

Another problem for women with hypothyroidism is thyroid requirements can change rapidly in early pregnancy. I suspect many are not being tested early enough with a view to increasing doses. Again lack of medical contact and lack of knowledge from some GPs/ midwives is a problem.

[Absofrigginlootly]

www.nice.org.uk/guidance/ph11/chapter/4-recommendations

[Absofrigginlootly]

I can't access that second link from the states... It says you have to be in the uk. Anyone care to read it and report back..??

[Butterchunks]

I'm not sure the information regarding the chemical difference between folate and folic acid in the op is correct.

I had my baby earlier this year but on the basis of this anecdotal evidence I wouldn't have changed what supplements I took. The is a lot of good quality, peer reviewed research that goes into how the NHS practice medicine. That is where I got my trustworthy information from.

[Lolloveswoody]

As I said the studies are there to prove it is more than 'anecdotal evidence'.
www.ncbi.nlm.nih.gov/m/pubmed/23482308/?i=6&from=/20608755/related

[Lolloveswoody]

www.ncbi.nlm.nih.gov/m/pubmed/16825690/?i=10&from=/20608755/related

[Lolloveswoody]

www.ncbi.nlm.nih.gov/m/pubmed/24032278/?i=28&from=/20608755/related

[NoMudNoLotus]

The studies linked here are not of good quality.

[NoMudNoLotus]

The NHS is committed to providing sound evidence based recommendations.

The reason why these recommendations change is because there is ongoing research - not for any other reason.

[ohlittlepea]

Agree with no mud.
It is heart breaking for your friend to loose her baby, and kind of you to try to help. However it does not sound like folic acid would have helped in this case, if she was already taking the recommended dose and for long enough prior to conceiving then she had the optimum amount on board.
As well as continuous review in the NHS and by scholars, charities review the evidence. If there was a strong case for folate...it would be recommended.
The NHS has a huge focus on evidence based practice. Systematic reviews are used to evaluate trials and evidence to find statistically significant benefits.
The nhs have clear guidelines on caffeine intake in pregnancy also.

[babba2014]

I think in lots of aspects nowadays we are encouraged for the cheaper option rather than more natural. And relying on mainstream advice makes many of us not research?
It's like having low iron in pregnancy. Immediate reaction is to prescribe iron tablets as they literally cost pennies but most people (or everyone) I know suffer from side effects like constipation which is awful in pregnancy. The alternative is liquid iron (not the one which is the tablet in liquid form, but rather, spatone). Spatone costs a lot more but they can prescribe it. Most GPs won't because of cost but you can buy it over the counter and it is very effective in getting iron count high (which is important if you suffer a blood loss). It doesnt even take long to get levels high as in both my pregnancies I only took them for a couple of weeks.

Another one is diet. Eat what you want in pregnancy, it's the one time you can? In reality that's why the gestational diabetes rate is higher than what it could be? Pregnant women should be encouraged to eat well from the start but society is very different now. The moment I cut out processed food and sugar, my blood readings were fantastic. I was shocked at how even a bit of sweets and chocolate every day, or even a takeaway made me feel all giddy.

Despite all of the above, I shock horror, went for a home birth. And I was okay. We rely a lot on NHS general advice etc but when you go and research yourself to find both sides and weigh them yourself for your own situation, typically find a whole different world out there.

[Mummyoflittledragon]

Some people cannot absorb synthetic vitamins. They have to be processed by the body / liver before becoming available to use. Some people's bodies cannot convert these synthesised vitamins into the absorbable form. Better to purhase in the natural / bio available form even though they cost extra as the average person has no way of knowing whether or not their body can absorb synthetic vitamins. Mine can't.

[scaevola]

One thing that doesn't seem to be mentioned enough is that anti-malarials can strip your body of folic acid, and if you have been taking them you need a far higher dose (just like those on certain epilepsy meds do).

[user1471552005]

Is the state responsible for people making poor dietary choices?
Folic acid supplements are only necessary because lots of women eat crap food,