Folate and pregnancy

Taking the vitamin folate before and during pregnancy reduces the risk of your baby having a neural tube defect (conditions in which a baby’s spine, brain and skull do not develop properly).

What is folate?

Folate or folic acid (the synthetic form of folate) is a B group vitamin that is vital for normal cell growth and development. It should be an important part of your normal diet but is especially important if you could possibly become pregnant, are planning a pregnancy or are in the first trimester of pregnancy.

What foods contain folate?

Folate is found naturally in:

• green leafy vegetables
• cereals
• fruits
• grains
• legumes (for example, beans, peas and lentils)
• wholegrain breads
• orange juice.

I’m planning a pregnancy – should I take extra folic acid?

Yes. In addition to a healthy diet high in folate rich foods, you should also take folic acid supplements. These are available from health food stores and chemists.

A high folate intake can help prevent up to 70 per cent of neural tube defects. It is important to remember that folate cannot prevent all cases of neural tube defects.

How much should I take and when?

In addition to following a healthy diet, it is recommended that you take an extra 0.5 mg of folate or folic acid daily, at least:

• one month before conception (when you become pregnant)
• for the first 3 months of your pregnancy.

Some women may need a higher intake of folate, including women who have:

• spina bifida or epilepsy
• had a previous pregnancy affected by a neural tube defect
• a family history of a neural tube defect.

Ask your doctor or pharmacist for more information on folate during pregnancy.

Neural tube defects

Neural tube defects occur when the spine, brain and skull of a baby do not develop completely.

The neural tube is a hollow, tube-like structure that protects the brain and spinal cord. If the neural tube doesn’t close at any part along its length, the baby will have a neural tube defect. Many babies born with a neural tube defect have varying levels of disability. Some may be stillborn or die shortly after birth.

In Australia, around one in every 700 pregnancies is affected by a neural tube defect each year.

Causes

Development of the neural tube is affected by both genetic and environmental factors. Factors that increase the risk of your baby developing a neural tube defect during pregnancy include:

• not enough folate prior to and during the first 3 months of pregnancy
• the use of certain medications (for example, drugs used to treat epilepsy)
• maternal diabetes
• environmental factors
• your ethnic background.

There are three types of neural tube defects

Spina bifida (split spine)

In this condition the neural tube fails to close, leaving a hole that allows the spinal cord to pop out through the spine. This can occur anywhere along the spine, but is more common toward its base.

Babies born with spina bifida have varying degrees of disability, including:

• paralysis
• bowel and bladder problems
• difficulty walking
• scoliosis
• hydrocephalus (a build up of fluid on the brain)
• learning difficulties.

Anencephaly

This condition affects the skull rather than the spine. The upper end of the neural tube does not close which means the brain and skull do not form properly. Babies with anencephaly die soon after birth.

Encephalocoele

This is a rare condition in which the brain and covering tissue poke through a gap in the skull. Babies with encephalocoele have varying degrees of physical and intellectual disability.

Detecting neural tube defects during pregnancy

Two tests are available to detect neural tube defects during pregnancy.

Second trimester maternal serum screening

A sample of your blood is taken and tested to predict the risk of your baby having a neural tube defect. This test can be performed between weeks 14 to 18 of your pregnancy, but ideally it is done between weeks 15 to 17. This test will classify your pregnancy as either:

• not at increased risk – your risk of having a baby with a neural tube defect is very low
• at increased risk – your risk of having a baby with a neural tube defect is higher, somewhere between 1 in 12 and 1 in 128.

Find out more about prenatal screening for genetic conditions.

Structural ultrasound

An ultrasound performed between weeks 18 and 20 weeks of your pregnancy can be used to screen for spina bifida and other neural tube defects.

More information

• Talk to your GP.
• Phone the Genetic Services of Western Australia on 9340 1525.
• Phone the Fetal Medicine Service at King Edward Memorial Hospital on 9340 2700 or 9340 2705.

Remember

While folate cannot prevent all cases of neural tube defects:

• A high folate intake can help prevent up to 70 per cent of neural tube defects (when a baby’s spine, brain and skull do not develop properly).
• Having enough folate in your diet – from foods containing folate and by taking folic acid supplements – improves your chances of having a healthy baby.
• Taking extra folic acid in the month prior to being pregnant and the first 3 months of pregnancy reduces the risk of neural tube defects.

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.