Does Taking A Prenatal Vitamin Really Matter?

Are you taking a prenatal vitamin? This is one of the first of several questions your provider may ask you after finding out you are pregnant. Most women know they are supposed to take a vitamin while pregnant but don't understand why. They then start taking one too late which limits the positive effects. A healthy well rounded diet should always be a mom to be's number one goal but it is not possible for most women to get everything they need from diet alone. Growing a healthy baby starts prior to conception and taking a multivitamin that contains folic acid should begin prior to pregnancy as well. 

Why should I take folic acid?

The CDC and the US Public Health Service urge women to take 400 mcg of folic acid everyday to prevent birth defects of the baby’s brain and spine. These defects are called Neural Tube Defects and in some cases can be prevented. Defects include Spina Bifida (improper formation of the spinal cord outside of the bones of the spine), Anencephaly (the top of the skull and brain do not form properly), and Encephalocele (part of the brain is outside of the skull). Folic acid is a B vitamin that helps with new cell growth and ensuring an adequate storage of this vitamin in your body prior to pregnancy is critical.

When should I start supplementing?

Your baby’s brain development begins in the first few weeks of pregnancy. This means that during the 2 weeks before your missed period some of your baby’s most critical development is taking place. Most women, however, don't take a pregnancy test until they miss their period and then dont begin to take a vitamin until after the pregnancy test is positive or have been in to see their provider which means that your baby is missing out on the benefits of folic acid. As a result, if you are a woman who could get pregnant you should also be taking a multivitamin that contains folic acid. Try to take your supplement daily but don't panic if occasionally you forget to take your vitamin. Additionally, many women in the first trimester struggle with nausea and vomiting and the prenatal vitamin makes it worse. These women may benefit from taking the vitamin at night, switching to a gummy vitamin (I like mine cold from the fridge) or taking folic acid alone as it is a smaller (less stinky!) pill. 

What are the risks associated with folic acid?

It is likely there are multiple causes of neural tube defects. Lack of folic acid (folate) when the neural tube is forming is just one cause. There may be a lack of folic acid even if a woman eats well and does everything she can to have a healthy baby. Some women and babies may have a higher need for folic acid, and there is currently no way to tell who they are prior to pregnancy.

Other risk factors for having a child with a neural tube defect include insulin-dependent diabetes in the mother and certain medications which may be used to control maternal epilepsy. It has also been questioned whether elevations in a woman's body temperature when the neural tube is forming, either from a high fever or prolonged exposure to hot tubs or saunas, can cause neural tube defects. Finally, neural tube defects can be part of a genetic condition that has other features as well. If you have questions regarding your own situation, a genetic counselor may be able to help.

https://www.cdc.gov/ncbddd/folicacid/documents/wsk.pdf

Where can I find folic acid and why is food not enough?

Consuming folic acid is one way we can minimize the risk of neural tube defects. This supplement can be found as part of a multivitamin (400mcg) or prenatal vitamin (800mcg) or as its own over the counter supplement (400mcg tablets). Many breakfast cereals have also been fortified with folic acid, but be sure to check the box labeling as not all contain this additive. As you can see in the chart below it is hard to consume an adequate amount of folic acid daily from your diet alone. Generally over consumption from food sources is not a problem. Consuming too much folic acid from supplements however can mask other health concerns and should only be taken at high levels if prescribed by your provider. 

 Special Considerations

Talk to you provider if you have had a baby born with a neural tube defect about planning for your next pregnancy or if you have been told you have a genetic mutation that changes the way you absorb folic acid. Weight loss surgery may also affect the way your absorb nutrients and special supplementation and monitoring will therefore be needed when pregnant. A well rounded diet is always a good idea in pregnancy and if you follow any restrictive diets you may also want to consult a nutritionist for other ways to ensure an adequate diet in pregnancy.

The best indicator for a healthy pregnancy is the health of the mother prior to conception and diet and exercise alone just one piece of the equation. Consider setting up a preconception visit with your provider to discuss any medical conditions that may affect your pregnancy. I can guarantee that he/she will also ask you if you are taking a vitamin.

Additional Resources:

CDC: Centers for Disease Control and Prevention

NIH: National Institutes of Health- Office of Dietary Supplements