Do you want to conceive a baby soon? Are you wondering if you need to prepare before becoming pregnant? Have you stopped using contraceptives and you might become pregnant at any moment? This is an article for you!

You may become pregnant without having planned it, and that’s why the Society of Obstetricians and Gynecologists of Canada (May 2015) recommends that all women in their childbearing years take multivitamins with folic acid. If you become pregnant, the protective effects of folic acid and other vitamins for the developing embryo will already be active at the start of pregnancy.

Folic Acid Effects

Research has shown that taking folic acid orally during the pre-conception period significantly reduces problems associated with neural tube closure (formation of the spinal cord, for example, spina-bifida) and the combination with multivitamins also has a positive effect, preventing anomalies such as cleft palate, urinary tract, heart and limb malformations.

Folic acid is a complex B vitamin. It dissolves in water and is absorbed in the intestines and is eliminated in urine.

Did you know that since 1998, Health Canada has folic acid added to white flour, pasta and cornmeal to prevent neural tube problems in the general population? It seems to have diminished the occurrence of the problem. Studies have shown that it works, as, over the past several years, higher levels of folic acid in the blood have been noted in the general population, including women in their childbearing years.

Sources of Folic Acid (Folates)

There are many sources of folic acid (folates). Many foods contain folic acid and generally meet a person’s needs. But for a woman who may be pregnant, a simple diet makes it difficult to meet suggested blood dosages (folates in red blood cells) to have a protective impact against several malformations.

You will find high levels of folic acid in broccoli, peas, corn, spinach, Brussel sprouts, lentils and oranges.

Recommendations if you want to conceive soon

You need to maintain a balanced diet, rich in folates and take multivitamin supplements containing vitamin B-12 and folic acid.

It is important to maintain a balanced diet rich in folates and to include a multivitamin containing vitamin B-12 and folic acid as a supplement to your daily regimen.

Your caregiver, doctor, nurse, pharmacist or midwife can suggest the dosage level based on risks due to your health condition, family history (mother and father) to maximise the impact of folic acid on risks for your baby. 

We know that folic acid is absorbed in the intestine, so your caregiver may prefer to increase the recommended dosage depending on whether you have an intestinal health problem, such as Crohn’s disease. They may also increase the dosage if your spouse’s sister had a child with spina-bifida (family history). 

If you are treated with medication for specific health problems, some molecules will impact folate metabolism, reducing their absorption, which will also require an increased dosage to compensate. Some drugs are already identified for this: metformin, methotrexate, chloramphenicol, sulfasalazine, phenobarbital, barbiturates and several others. 

Folic Acid Dosages

We don’t know if there are risks in taking too much folic acid over a long period. That’s why it’s essential to be careful, taking the recommended amounts for both safety and prevention.

There are three possible levels of risk evaluated by your health professional. After examining you, they will determine the risk of your baby having problems with the formation of the neural tube or other malformations is low, medium or high. The dosage they will recommend will be based on this risk evaluation.

Low Risk

No risks were identified during their evaluation of congenital illnesses and will recommend the basic supplement dosage:

0.4mg of folic acid contained in a daily multivitamin. Ideally, start three months before conception and continue up to six weeks postnatal or when you stop breastfeeding

Medium Risk

A medium risk evaluation will be made if you or your spouse have a risk of congenital anomalies associated with folates: heart, smaller joints, cleft palate, urinary tract, congenital hydrocephalus, or neural tube anomalies in the close family (mother-father, brother-sister, uncle-aunt).

If you have a wife with type 1 or 2 diabetes (the medication can reduce folic acid absorption), chronic intestine problems, kidney illnesses or abusive use of alcohol. The preventative dosage will be increased to compensate for your situation.

1mg of folic acid contained in a multivitamin, also starting three months before conception and during the first trimester of the pregnancy, then reducing the dose to 0.4-1mg for the rest of the pregnancy and postnatal period.

High Risk

High risk refers to the fact that you or your spouse have been affected by a malformation of your neural tube, and you also have a child with the same affliction. The dosage will also be increased given the risks are very high for your baby. There are two possible dosages in this case:

Based on recommendations from the Canadian Nutrition Society in April 2018, a dose of 4mg of folic acid should be taken (3 1mg pills) in addition to a multivitamin (containing 1mg of folic acid) three months before conception and then 0.4-1mg for the rest of the pregnancy and postnatal period.

or

In rare instances, you can also take a multivitamin with 5mg of folic acid under advisement by your health professional, three months before conception and for the first trimester, then lowered to 0.4-1mg for the rest of the pregnancy and postnatal period.

New:

There are now pregnancy multivitamins that, in addition to folic acid, contain omega 3 (ADH) for mothers that don’t eat fish in their diet. The omega 3 comes from very tiny fish that contain very low levels of heavy metals. This helps to improve the development of the baby’s cerebral functions. They don’t taste like fish, no smell, no burping! Something good to know!

Precautions

You should note that if it takes longer than eight months to become pregnant, you should diminish your folic acid to 0.4mg per day, even if you have high risks. Continue for another six months and then talk to your health professional about what to do to avoid taking supplements over too long a period.

This article is intended to provide helpful guidance and support in taking steps to prevent potential issues that may affect the baby. Taking every necessary step to ensure the baby’s health is of utmost importance!

Marie Fortier
The Baby Expert