I believe that for many of you who are planning to get pregnant or are already pregnant, the word “folic acid” is already familiar to you. However, we are not sure about “why?” and “how? and “how to take it?” These two questions are still not clear to many of you. In view of the important role of folic acid in the prevention of fetal neural tube defects, I think it is necessary to talk about the topic of “how to properly supplement folic acid”, so that we can have a more correct knowledge of folic acid supplementation before and during pregnancy. What is folic acid? Folic acid is one of the B vitamins, also known as vitamin B9, which was first extracted and purified from spinach in 1941, hence its name. It is composed of pteridine, p-aminobenzoic acid and LC glutamic acid, also called pteroyl monoglutamic acid. The human body cannot synthesize folic acid and must rely on exogenous supplies. Folic acid is abundant in fresh fruits, vegetables, and meat foods. It is mainly absorbed in the duodenum and proximal jejunum, and the amount of folic acid stored in the human body is 5-20 mg. Folic acid is mainly excreted in urine and feces, and the daily excretion is 2-5 μg. There are many foods containing folic acid, but since folic acid easily loses its activity when exposed to light and heat, the human body can not really get much folic acid from food. For example, vegetables lose 50% to 70% of their folic acid after 2 to 3 days of storage; cooking methods such as boiling soup will cause 50% to 95% loss of folic acid in food; vegetables soaked in salt water will also lose a lot of folic acid content. What is neural tube defect? When it comes to folic acid, we have to talk about what is neural tube defects? Neural tube defects are serious congenital anomalies common in newborns, including anencephaly, spina bifida and cerebrospinal bulge. Fetuses with neural tube defects often die in the perinatal period, and even if they survive, they have severe functional impairment. China is a country with a high prevalence of neural tube defects, with a national average incidence of about 1 in 1,000. The nervous system begins to differentiate around day 18 of embryonic development until the complete closure of the neural tube at the end of day 4, which is a critical period for neural tube development and is particularly sensitive to factors that can hinder or interfere with the normal developmental process. The cause of neural tube defects is still unknown, but it is generally believed to be an interaction between genetics and the environment, with folic acid levels being the most closely related of the environmental factors. Folic acid supplementation is an important tool to prevent the development of fetal neural tube defects. What is the relationship between folic acid and eugenics? Under normal circumstances, the daily intake of fresh vegetables, fruits and meats in sufficient quantity without picky or partial eating can meet our daily needs for folic acid. However, because of the special physiological state, the requirement of folic acid for pregnant women is four times higher than that of normal people. Insufficient intake of folic acid during pregnancy can easily lead to folic acid deficiency due to the increased need of folic acid. Because folic acid is involved in almost all biochemical and metabolic processes and thus has an important role in both cell division and growth. Folic acid deficiency in the body slows down DNA replication and affects cell division and proliferation, causing neural tube mutations in the fetus during early pregnancy, resulting in anencephaly and severe spina bifida, and limiting the rapid development of the fetus and placenta, leading to miscarriage, placental abruption and fetal malformations; the hematological system is characterized by reduced hemoglobin synthesis and failure of red blood cells to mature, resulting in megaloblastic anemia. In addition, studies have shown that folic acid deficiency is also associated with recurrent spontaneous miscarriage, hypertensive syndrome during pregnancy, and the occurrence of fetal Down syndrome, cleft lip and palate, congenital heart disease, urinary system malformations, limb shortage, and other malformations. Since many women do not have enough folic acid reserves in their bodies to supply their folic acid needs in early pregnancy, women who are preparing for pregnancy need to take folic acid in advance to increase the reserves of folic acid in their bodies. Numerous clinical studies have proven that women who start folic acid supplementation early in pregnancy can reduce the chances of fetal cleft lip. Taking 0.4mg of folic acid during pregnancy preparation can reduce the rate of fetal neural tube abnormalities by 85%. For many years, our government has been distributing free folic acid to increase the rate of folic acid intake among pregnant women, thus preventing and reducing the occurrence of birth defects during pregnancy and achieving eugenics. How do I know if I am folic acid deficient? By drawing 2-3 ml of venous blood, you can find out the level of folic acid in your red blood cells, and then take folic acid supplements under the guidance of your doctor. How to choose the folic acid dosage? How do I take it? Since there is a wide range of folic acid and folic acid-containing drugs on the market, many of you do not know how to choose folic acid. Folic acid is not necessarily the more expensive the better. In fact, many of the more expensive health products contain less than 0.4mg of folic acid at all, which has limited preventive effects. To summarize, there are four most common doses of folic acid: 0.4mg, 0.8mg, 1.0mg and 5mg, except for the 5mg folic acid which is used to treat megaloblastic anemia caused by folic acid deficiency, the remaining three can be used for pregnant women and women preparing for pregnancy. When choosing folic acid products, you can take into account your own economic situation. A bottle of folic acid tablets of more than 10 yuan is sufficient to meet the needs of folic acid supplementation. More studies now believe that the intake of multiple micronutrients can improve the utilization of folic acid, and in addition these micronutrients are very important for the healthy development of the baby, therefore, if economic conditions allow, you can choose multivitamin tablets containing folic acid. We recommend that folic acid be taken from the first trimester of pregnancy, emphasizing that the purpose of starting to take it before pregnancy is to maintain a certain level of folic acid in a woman’s body to ensure a better nutritional status of folic acid in the early embryo. According to research, it takes 4 weeks after a woman takes folic acid for the folic acid deficiency in her body to be corrected. This way, during the sensitive period of fetal neural tube formation in early pregnancy, sufficient folic acid can meet the needs of neurological development, and it has to be taken consistently during the sensitive period in the first trimester of pregnancy to have the best preventive effect. If I didn’t take it before pregnancy, can I still take it after pregnancy? There are many women who have already gotten pregnant without taking folic acid before conception. Then, we also recommend to start taking folic acid at the same time when you know you are pregnant, which can also play a preventive role. Can too much folic acid be toxic? Folic acid is a water-soluble vitamin that does not accumulate in fat and generally does not cause toxicity even if it exceeds the minimum adult requirement by a factor of 20. If there is excess folic acid in the body, it will be excreted in the urine. However, it is important to note that pregnant women should not take large doses of folic acid tablets (5mg) during pregnancy, because long-term high doses of folic acid tablets can interfere with the zinc metabolism of pregnant women, and inadequate zinc intake will have adverse effects on the pregnant woman and the fetus. How to supplement for women who have previously conceived babies with neural tube defects? It is important to inform your doctor before preparing for another pregnancy if you have previously conceived a baby with a neural tube defect. If no action is taken, women with this condition have a 2% to 5% chance of conceiving another baby with a neural tube defect. Pregnant women who have had a baby with neural tube defects should take a folic acid supplement of 5 mg per day, 3 months before conception, because these women have a more severe deficiency of folic acid in their bodies, so that their folic acid levels can be gradually built up and gradually reduced after pregnancy. The supplementation of large doses of folic acid may mask the symptoms of vitamin B12 deficiency and interfere with the metabolism of zinc, causing zinc deficiency, so it is recommended to supplement vitamin B complex and zinc at the same time. Should folic acid be taken by fathers-to-be? I am often asked in my outpatient work whether folic acid should be taken by the father-to-be? There is no definite evidence or experimental studies to prove that folic acid can cause malformation in the baby if the father-to-be does not take it. However, studies have shown that folic acid deficiency can reduce the concentration of semen and may cause abnormal chromosome segregation in sperm, which may lead to disease in the future baby. Therefore, we recommend that folic acid should be taken orally by fathers who are “preparing for pregnancy”. Friends, it is the wish of every family to have a healthy baby, and we need to start from little by little. A small capsule of folic acid can play an important preventive role, and couples planning to have a baby are advised to take 0.4-0.8mg of folic acid daily from 3 months before conception, and again, it is best to go to the hospital to have your red blood cell folic acid level tested and then choose folic acid products wisely.