Folic Acid

Dec 17, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Toddlers versus teenagers. That would be a great movie. I know my choice for which group is most annoying. But since the new X-Files starts in 2016, lets start with the conspiracy. Wednesday nights Doris goes bowling, so I get the kids all to myself. In the early 2000's, Doris and some cigarette smoking man hatched a plot. For the last decade, every Christmas concert I've attended has happened on solo parenting night. Concert day starts with Doris going to the afternoon show and then being snatched by aliens or bowling or whatever. Then I have to rush home from work, throw food down the gullets of two festively decorated children without damaging their outfits and get them to the concert. I remember being especially annoyed when Emily was in Kindergarten and Grade 1. In those years, I had to take toddler Eric with me. Sitting still for the whole concert was not his idea of a good time and he let everyone know.

That was years ago now. Recently I went to see Eric and his Grade 5 class rap about Christmas at Barker school. I must be getting soft headed in my old age, but I actually enjoyed it. Maybe by the time Im a grandparent, Ill look forward to Christmas concerts. My date for the Wednesday evening Barker Christmas Extravaganza was less pleasant. Thirteen year old, grade 8 Emily had zero desire to be at the Christmas celebration.

Before having a toddler, all you and your spouse are hopping for is a healthy baby. Before getting pregnant, talk to your doctor about a prenatal care plan which includes folic acid. Since pharmacy school, it has impressed me how important folic acid is. Folic acid is a B vitamin. Like most vitamins and minerals, it is best to get it from the food we eat. Folic acid is in beef liver, oranges, legumes and dark green vegetables. Folic acid is required for new cell growth, formation and maintenance especially during periods of rapid growth. Some people on the arthritis medication methotrexate may need extra folic acid supplements. However, maybe the most important group of people that should watch their folic acid intake are women of child bearing age. While planning a pregnancy, and BEFORE becoming pregnant, it is important for women to start taking folic acid. It can prevent certain birth defects from occurring.

Birth defects, or congenital defects, are physical abnormalities that are present at birth. About 3 to 4 percent of babies are born with a major birth defect, although some may not be discovered until a child grows. By age five, 7.5 percent of all children are diagnosed with a birth defect, although many of these are minor. The type of birth defect that is associated with a folic acid deficit is called a neural tube defect. Neural tube defects (NTD) include anencephaly and spina bifida. Anencephaly is when the child is born with most of its brain missing. The infant cannot survive and is either stillborn or dies within a few days of birth. Spina bifida is when one or more of the vertebrae fail to develop completely leaving a portion of the spinal cord unprotected. Spina bifida is strongly linked with folic acid deficiency in the diet, especially early in pregnancy. Symptoms can vary. Some children with Spina bifida have few or no symptoms, whereas others can be weak and paralysed in all areas reached by nerves below the level of the spinal cord defect.

To prevent neural tube defects, folic acid supplements should be taken before becoming pregnant, and continue throughout the first trimester. The neural tube forms and closes in the first four weeks of pregnancy. This is often before pregnancy tests can tell if you are pregnant. That is why it is important to start folic acid before you are pregnant. A minimum of 0.4 mg of folic acid daily is recommended for women who are planning to become pregnant. Higher doses up to 5 mg are recommended for women who have a high risk of having a child with a neural tube defect. If you think you are at high risk, consult your doctor before starting high dose of folic acid. Prenatal vitamins, such as Materna, contain as much as 0.8 to 1 mg of folic acid, and these vitamins should be used in pregnancy rather than regular vitamin formulations.

A study out of the UK suggests another reason to start folic acid before one becomes pregnant. Hodgetts et al. published a paper in the November 2014 British Journal of Obstetrics and Gynaecology that linked folic acid and low birth weight. Their study showed that women who started taking folic acid before they got pregnant had less small for gestational age babies. These small babies have a greater risk of developing diabetes, high blood pressure, obesity, heart disease and mental health issues as adults than normal sized babies. Another study in February 2014's JAMA by Pal Suren et al. looked at newborns in Norway between 2002 and 2008. Their study showed that if mothers started folic acid before becoming pregnant their children were less likely to have autism.

If you are thinking about starting a family, talk to your doctor. Talk about folic acid and the other things that should be done to prepare for your future family before becoming pregnant.

Toddlers have short attention spans, want to eat nothing but candy and throw tantrums. Teenagers pretty much the same thing. But unlike when I took toddler Eric to Emily's Christmas concert many years ago, teenaged Emily started complaining days before the Eric's concert happened, and complained the whole way through. At least toddler Eric was kind of excited to be in a new place for a short time before he got bored, tired and cranky. Teenaged Emily wins the least pleasant child to bring to a Christmas concert award.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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