Folic Acid???????

[vernonioNR1]

Hi all,

Not sure how common this is, but a husband here actually posting to try and find some advice to allay my wife's fears... i'm hoping you can help.

We recently found out we are expecting a baby and could not be more pleased, we've been trying for a little while!! And whilst excited it has led to a little anxiety. Let me explain.

My sister has Spina Bifida, and advised us months ago to take folic acid regularly if we were trying, which we have been. So every night my wife has been taking the folic acid capsules (the regular over the counter size). Upon finding out we were expecting my wife went into overdrive 'googling' everything and on the NHS website (and others) it states those parents that have siblings with Spina Bifida should take a higher dose (5mg i think??) - although this needs to be prescribed.

We went to the doctor with the good news, but also this folic acid concern, and she seemed to think what we were doing with normal doses was absolutely fine, and no need for the higher dose. However, my wife had to phone the doctors a couple of days ago as she was worried over some blood appearing (apparently can be normal) and mentioned the folic acid to this other doctor. This doctor apparently checked the NHS website and the prescribed the folic acid... my wife now has no idea what to do, is worried she has harmed the baby as we didn't start taking it sooner, but also, are there any side affects to taking a higher dose??? We're six weeks along, so can take for another six weeks as i understand it.

Have we been really stupid? is it detrimental to the baby? is there any point in taking the higher dose now?

Any help or advice, or previous experiences would be really helpful to me when chatting this through with my wife.

Many thanks in advance

Routinely women should take 400mcg daily whilst trying to conceive and for the first 3 months of pregnancy. With a higher risk of neural tube defects (and this includes a family history) she should take 5mg folic acid daily. It is very hard to overdose on folic acid, so if I were her I would definitely take the prescribed 5mg from now on.

Yep, start taking the higher dose now. IIRC the body wees out the excess so there's nothing to worry about.

Whats done is done but definitely continue with the higher dose up until 12 weeks as there is still significant neural development going on up in the fetus all throughout the first trimester.
Its great that you (your wife) were taking folic acid before getting pregnant, then she will have built up a nice full store in her body which the baby will have been using in the early weeks. Also don't forget that the supplement is not the only source of folic acid that your wife will have been getting, it is in all manner of foods including potatoes, green vegetables, orange juice and many fortified breakfast cereals. So she will have been getting more than the 400mcg minimum dose anyway.

I really wouldn't worry (hard I know), there are many unplanned pregnancies that people wouldn't know about until 4-6week in anyway, so wouldn't even start folic acid until then. Shes definitely given her body a head start towards having enough folic acid by taking the normal dose prior to conception (your body can store it up for when needed).

The 5mg advice is fairly modern I believe and is more just to be triply sure. Also if you're on 5mg they normally say to take that until 14weeks, rather than 12weeks and then to take the normal over the counter ones for the remainder of pregnancy.

Hi there, I am nearly 30 weeks pregnant and didn't take any folic acid. There are hundreds of women who don't even realise they are pregnant and go past the 3 month period without taking them. Does your wife have a balanced diet?! If so, she should get plenty of nutrients etc through food. If she has been taking additional folic acid of any dose I'm sure this will reduce the risks greatly.

My mum has Spina bifida and I wasn't aware about the higher dose until my 8 weeks booking in appointment with the midwife. I requested it from my GP and started taking it at around week 9. He actually gave me shed loads of the stuff so I carried on taking it till about 20 weeks I think. Its water soluble so you will pee out what you and the baby doesn't need so there's no risk of over dosing.

I did a lot of research on this too. The main risk factor for Spina Bifida is malnutrition. Therefore the risk nowadays is actually very low, so much of our food is fortified with folic acid (eg cereals) and our diet is so much better than it was years ago. Look up the kind of foods folic acid is found naturally in, this might give your wife some reasurrance if she eats plenty of green veg etc.

I was also told by my GP that the incidence of congenital Spina Bifida is extremely low. I think the wording he used was 'incredibly remote'.

So try not to worry. Although I'll admit I was on tenter hooks until the 12 week scan.

I was advised to take the higher dose a month before TTC and continue right the way through the pregnancy which I have been doing. I would advise your wife to take the higher dose as it can certainly do no harm.

As others said it is water soluble so no danger taking higher dose. Ad if it is prescribed at 5mg then it is seen as safe to take in pregnancy. The good news is your wife was taking folic acid before pregnant and also taking it in first two weeks of pregnancy. When she has first midwife appointment worth asking a midwife when to stop taking it ( they may recommend carrying on after 12 weeks). Also a health diet will contain some useful vitamins and minerals.

Sorry I should add I have 5mg prescribed for medical reasons and take it all through pregnancy.

Hello, there is actually no evidence that the high (5mg) dose is any better than the standard 400ucg dose at preventing neural tube defects. Most of the rest of Europe don't use it, and there, even those considered at increased risk are advised to take the standard dose. There is no evidence of harm from the high dose, so okay to take it from now if your wife wants to. Hope this helps

Its too late now so you need not worry. The spinal cord forms at week 7 so really isn't necessary to up the dose now. Spina bifida is extremely unlikely. Continue with the regular dose. Best of luck. And think positively x

I had a similar thing happen and can understand your worry. There's a history of Spina Bifida on one side of my family, so I was taking the normal dose of folic acid for a few months prior to getting pregnant. I went to talk to my ob/gyn (I'm in the US, where we tend to go straight to specialists rather than through a GP) just before I got pregnant and she prescribed a higher dose -- the 5mg, which I'm now taking. She definitely said it was worth taking the higher dose prior to conception and through the first trimester. (Although I was actually just pregnant by the time I picked up the prescription and started taking it! So I've just been taking it from the first week onwards :)

But my ob/gyn also pointed out that the risk factor depends on how close the blood relative is, who had spina bifida. In my case, it was an aunt and a sibling, which she said wasn't really that high a risk -- something I was quite surprised by. She said it would have been more of a worry if it had been a parent or a prior child of mine.

In your case, as its your sister who had SB, it might also not be as high a risk as you're assuming (and as I assumed, before I talked to the specialist). But I would go ahead and take the higher dose until you're through the first trimester anyway. It won't do you harm to take more folic acid, and it'll probably put your mind at ease to know you're doing so.

It is no an exact science and you have been on it pre conception which is important so good planning! You will have reduced the chances of your baby being affected considerably. It is a pity that more people do not plan ahead but we are up against nature and all she wants is more babies!

I was prescribed 5mg by my consultant when we found out we were having twins at 12 weeks. I was prescribed this until my twins were born.

I took over the counter Folic Acid from 4 weeks when I found out I was pregnant.

I take 5mg of folic acid everyday and have done for the past 6 years. I'm on an anti-epileptic and they are anti-folates. Annoyingly, most GPs seem to forget that anyone on an anti-epileptic needs to be on 5mg folic acid even though it is in government guidelines.

From the research I did, it appears to be impossible to OD on it and completely safe. I took it the whole time I was pregnant with DD and breastfeeding.

Folic acid also helps with red blood cell production and can therefore help reduce the risk of anaemia.

I've also heard that it can have an effect on mood - reducing the risk of depression.

Here is a leaflet that includes information on which groups are advised to take high dose folic acid in case anyone is interested

www.medicinesinpregnancy.org/Medicine--pregnancy/Folic-Acid/

Please don't panic!

If you think about it, the vast majority of women in history were not taking folic acid because no body knew that it was needed. They got what little they could from food. The vast majority of women didn't have babies with Spina Bifida.

Also there will be many modern women, who like me, spent the majority of their early pregnancies vomiting everything they swallowed. I took my folic acid tablets religiously but I doubt I absorbed an awful lot as they were not in my tummy for long. My DS is fine.

I think it's important not to get into the mindset of 'OMG what if we've harmed the baby' because that doesn't reflect reality. Pregnancy is a bizarre and strange lottery. You can do every thing the books tell you to do and still have a poorly baby. It's scary, but there is actually virtually nothing you can do about it, the situation is almost entirely random and out of you and your partners hands.

I wish you all the best.

By the way, I'm not suggesting that you don't take Folic Acid or don't take the higher dose. You should of course follow the doctors advice.

I'm just pointing out that things are probably going to be fine and worrying about it will get you no where!

She can take it all the way through. (That's what I'm doing too, 15 weeks now).

interested LittlePeas to know the source re where 'there is actually no evidence that the high (5mg) dose is any better than the standard 400ucg dose at preventing neural tube defects'.

As it is still routinely prescribed for people at higher risk of neural-tube defects e.g. women of child-bearing age with epilepsy/taking anti-convulsants, like pyrrah and myself. Been taking 5mg daily for 6 years too. Won't harm so suggest definitely continue with the higher dose and I was told to go straight through not stop at 12/16 weeks as I have read suggested elsewhere for low-risk mothers. But don't worry, as folk say she was taking the routine amount anyway and probably getting a decent amount from her diet too. (Re the scans, I am confused though - I thought it was only at the 20-week anomaly scan that neural tube defects might become apparent, but my obs consultant seemed to think that mine due at 19+1 might be too early for that. However a sonographer said that if things are seriously wrong it can often be picked up at the 12-week one, so hopefully yours will give you some reassurance).

it is widely know that folic acid helps prevent against neural tube defects
but can people please be aware the 5mg strength dose ALSO helps protect against heart abnormailites

so anyone with any history of congential heart problems
and ttc should be on the 5mg strength

Yes, 5mg dose for various 'higher risk' mothers - can I just point out that 'higher risk' does not mean 'it will happen'?

Really, don't panic.
She's taken the normal dose of Folic acid which is more than many do and is now switching to the higher dose - it will be fine.
She should of course tell her MW of her family history with spina bifida and this will be checked specifically at her detailed scan @ 20 wks.
She can also consider various screening blood tests - again, they give a probability, NOT a diagnosis.

Oh, and Folic acid is one of the B Vitamins which we don't store so we need a constant supply of it. It is found in many highly coloured vegetables and many fortified cereals.

Pregnancy can be a worrying and scary time - looking after a baby can be worse IME! Find a way to manage anxiety now rather when sleep-depriviation and looking after a baby comes in to the mix.

Congratulations to you both btw

Toucan there are no studies that have compared the efficacy of 5mg vs 400ucg at preventing NTDs. I work in teratology, that's how I know this. However, it is routinely prescribed to those considered at 'increased risk' because of e.g. Family history, obesity, or certain medications. However, it is also not known whether the mechanism by which certain anti-epileptics increase the risk of NTDs can actually be circumvented by folate supplementation, because that has not been studied either.

Also magicpixie it is still not known whether folate supplementation (either standard or high dose) decreases the risk of congenital heart defects, because studies of this have not all agreed.