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  • Writer's pictureJen Walpole

Folate Supplementation: From Preconception to Pregnancy & Beyond

Folate's Importance in Every Pregnancy Stage

A lot of emphasise is put on taking folic acid (or folate) during the first trimester, yet we know that a daily intake of vitamin B9 is essential. Let’s take a look at the importance of folate throughout pregnancy, from preconception to the fourth trimester.

Preconception: Taking folate during the preconception period is crucial for both male and female reproductive health. A minimum of three months' supplementation is often recommended because it's the approximate time required for both egg and sperm maturation. Because neural tube defects can occur in the first weeks of pregnancy, often before a woman realises she’s pregnant, it’s important to take folate prior to conception. For men, folate contributes to healthier conception outcomes and reduces the risk of miscarriage and genetic anomalies in the offspring. The preconception intake of folate is essential for DNA synthesis and repair, critical processes in the very early stages of foetal development. Ensuring adequate intake of folate through diet or supplements prepares the body for the demands of pregnancy and supports the foundation for a healthy pregnancy and baby. This proactive approach to prenatal health can have a profound impact on the well-being of both mother and child.

First Trimester: Folate is indispensable for the proper closure and development of the neural tube, which forms the early brain and spine of the embryo. It acts at the genetic level, influencing cell division and DNA synthesis, which are vital during the first few weeks of pregnancy when the neural tube is formed. Adequate folate levels reduce the risk of neural tube defects (NTDs), such as spina bifida, where the spinal column does not close completely, and anencephaly, a severe underdevelopment of the brain. The critical period for neural tube formation is within the first 28 days of conception, often before a woman knows she is pregnant. This is why adequate folate levels are essential before conception and during early pregnancy. Medical guidelines suggest women should take at least 400 micrograms (0.4 mg) of folic acid/folate per day, starting at least one month before conception and continuing through the first trimester. Research has shown that women who take the recommended amount before and during early pregnancy can reduce the risk of having a baby with a neural tube defect by up to 70%.

Second Trimester: As a pregnancy progresses, rapid cell division is a fundamental process for the growth and development of the foetus. Folate acts as a coenzyme in the form of tetrahydrofolate, which is involved in the synthesis of nucleic acids—DNA and RNA. This is especially crucial in the first few weeks of pregnancy when the foundations of the organs and bodily systems are being laid down. Furthermore, folate supports the development of the placenta, which nourishes the baby throughout pregnancy. The placenta’s cells divide rapidly and require DNA replication, for which folate is indispensable. Adequate folate intake is associated with a lower risk of several foetal growth restrictions and complications, partly due to its role in the development of a healthy placenta. The vitamin's involvement in amino acid synthesis and methylation reactions also affects gene expression and can influence foetal development outcomes. By contributing to the proper formation of the neural tube and supporting placental and foetal growth, folate plays a non-negotiable role in a healthy pregnancy. Hence why it’s so important for women to ensure sufficient folate is supplemented throughout pregnancy to support these critical developmental processes.

Third Trimester: Folate is paramount in red blood cell formation, a process especially vital during pregnancy when a woman’s blood volume can increase by up to 50%. This B-vitamin is essential for the synthesis of nucleic acids, which are crucial for the production and maturation of red blood cells in the bone marrow. Without adequate folate, the risk of developing anaemia increases, which can lead to fatigue and other complications during pregnancy. During the final weeks of pregnancy, the baby undergoes significant growth spurts, necessitating an increased production of red blood cells to transport oxygen effectively. Folate’s role becomes even more critical as it supports these surges in cellular proliferation and differentiation. This ensures that both mum and baby have sufficient oxygen and nutrients during this rapid growth phase, contributing to the overall health and development of the baby. What’s more, folate is involved in the synthesis of the amino acid homocysteine, and its adequate levels prevent homocysteine from reaching toxic levels, which could otherwise lead to complications such as preeclampsia. The critical role of folate in supporting the increased haematological demands of pregnancy and the intensive growth of the baby is why it’s strongly recommended to supplement adequate folate before conception and throughout pregnancy.

Fourth Trimester & Beyond: Folate is essential for breastfeeding mothers, as it supports the production of breast milk and ensures the milk contains adequate nutrients necessary for the baby’s growth and development. This B-vitamin is crucial for the synthesis of nucleotides, the building blocks of DNA, which is vital for the rapidly dividing cells in the growing baby. Since infants are in a stage of rapid development, the folate in breast milk aids in their cell division and growth, particularly in the nervous system. Additionally, folate plays a key role in the baby's brain development and the maturation of the cerebral cortex, which is responsible for many high-order functions such as thought, memory, and language. It also contributes to the infant's immune system development, making them less susceptible to infections and diseases. For mum, maintaining adequate folate levels during breastfeeding is crucial to replenish her body’s stores, which may be depleted during pregnancy. It also helps to prevent anaemia and supports mum’s overall health, which is essential for caring for a new baby. So, folate intake is important not only during pregnancy but also throughout the period of breastfeeding for the health of both mum and baby.

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