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Should I start taking folic acid before planning for pregnancy?

Q: I am a 27 years old female, planning for a baby now. I just got to know that folic acid should be taken before planning for pregnancy. Could you please let me know if folic acid supplements are suggested for all women planning to become pregnant? If it is not taken, what can be the consequences? Do I need to consult a gynaecologist before starting folic acid?

A:Folic acid is a vitamin of the B group vitamins and is largely harmless. This is not to say that all vitamins are harmless in pregnancy. High doses of Vitamins can be harmful to early pregnancy as we learned the hard way with the fiasco with vitamin A supplementation in Nepal and elsewhere. The current recommendation of taking 400 microgram of Folic acid daily when you are planning a pregnancy and up to 14 weeks of pregnancy are supposed to reduce the risk of neural tube defects (these are defect of the brain and spinal cord in formation of the baby and are indeed serious). This is the current recommendation and there is evidence that it is good and harmless. Folic acid is also available in food but in expensive foods like meat, fruits and green vegetables. This is a part of advice given to girls planning to get pregnant. Peri-conceptional (around the time of conception) nutrition is considered extremely important these days and it has bearing on the rest of the life of the offspring. Needless to say that there is no substitute for a healthy balanced diet compromising animal proteins, fruits, lentils vegetables and adequate dairy products. This is certainly essential. If you are unable to ensure enough of these it is a good idea to take 400 mcg of Folic acid daily at this stage. There is also increasing evidence that Vitamin D3 is very important in early pregnancy and 10 microgram per day is required. The best way is to get adequate sunlight exposure. For example 40 minute exposure to direct sun especially early morning and late evening sun is good. One way would be to consciously sit on the sunnier side of the car while going to/or coming back from work. If you pull your sleeve up and the exposure on the arm even through the window glass in an a/c car would be adequate. The problem is that 10 mcg Vitamin D3 and 400 mcg Folic acid tablets are not available in India and as I said it is not a good idea to take a high dose of anything, even a vitamin in early pregnancy. The minimal dose of Folic acid available in India is 5 mg (12 ½ times the dose required) please do not ask me why but that is how the pharmacology industry works. It is a cheap drug so no body is interested in marketing it. If you cannot get 400 mcg tablets (you will have to get from abroad where they are very cheap and over the counter) you buy the normal 5 mg tablet and take about a quarter of the tablet daily, it is a very small tablet and you will have to cut it with a sharp knife. It is not to say that any great harm will be done if you take the whole 5 mg but it is better to take the recommended dose of 400 mcg and no more. The same is the problem with Vitamin D3. The minimal dose available is 1.5 mg 105 times the dose required. So exposure to sunlight is the best solution. The multivitamin pills available abroad should be ok you can get Healthy Start in UK and any prenatal preparation in US. It has 400 mcg folic acid and 10 mcg Vitamin D3. Of course it also has a lot of other vitamins and mineral the significance of which are unknown but are hopefully harmless in the dose provided. You do not see a specialist just for this but it is always a good idea to go for counselling before planning for pregnancy. The doctor can give you a check up and find any health problems, which have bearing on your pregnancy, and you may be unaware of. Please do not make it a medical visit, as there are already enough problems with over-medicalising pregnancy. You are a healthy woman and should not subject your self to unnecessary investigations that make you feel like a patient. The visit should be used to discuss diet, nutrition, and a general examination and advice on weight blood pressure etc. If you are north Indian ruling out Thalassemia by a test call Hb electrophoresis of HPLC should be done and so should IgG for rubella (if it is still negative you should consider vaccination). A typical diet that I can suggest to you at this stage would be:-

  • 600 g of Dairy products (dairy products are better than milk as milk)
  • 50 g of animal protein (paneer/ one egg / white meat)
  • 5 fresh fruits every day
  • One bowl of vegetables each cooked and uncooked
  • A bowl of lentils every day
  • A handful of nuts (with skin)
  • A few dates and figs (Kaalaa anjeer)
  • Carbohydrates like roti and rice as required
I wish you all the best for your pregnancy.

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