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Folic Acid
Aka: Folic Acid, Vitamin B9, Folate, Folacin, Folic Acid Supplementation in Pregnancy
- See Also
- Folate Deficiency (causes Macrocytic Anemia)
- Serum Folate
- Indications: Supplementation
- Pregnancy
- Elevated Homocysteine levels
- Coronary Artery Disease prevention (disproven)
- Physiology
- Folate needed to convert Homocysteine to methionine
- Lowers Homocysteine levels (but does not appear to lower CAD risk)
- Preparations: Sources
- Meat
- Dark green leafy vegetables
- Spinach
- Romaine lettuce
- Dry beans
- Peanuts
- Wheat germ
- Yeast
- Enriched whole cereal grains (140 ug/100 grams grain)
- Dosing
- General
- Typical U.S. intake: 50-500 mcg/day
- Recommended Daily Allowance (RDA): 400 mcg/day
- Coronary Artery Disease prevention (not recommended)
- Folate 400 mcg to 5 mg (depending on Homocysteine)
- Not recommended due to low efficacy (lowers Homocysteine but not CAD risk)
- Dosing: Pregnancy
- General population
- Folate 400 mcg (600 Dietary Folate Equivalents or DFE) daily (as found in Prenatal Vitamins)
- Start at least 1 month before conception
- Continue for at least first 3 months of pregnancy (12 weeks postconceptions)
- Typically continued throughout pregnancy and Lactation
- Moderate risk
- Folic Acid 1000 mcg (1500 Dietary Folate Equivalents or DFE) daily
- Start at least 3 months before conception and continue at least until 12 weeks post-conception
- Some guidelines recommend the 4000 to 5000 mcg dose as given to high risk patients (see below)
- Indications
- Insulin Dependent Diabetes Mellitus
- Seizure disorder or anticonvulsant use
- Obesity (BMI>35 kg/m2)
- Neural Tube DefectFamily History
- High risk
- Folic Acid 4000-5000 mcg daily
- Start at least 3 months before conception and continue at least until 12 weeks post-conception
- Indications
- Prior Neural Tube Defect
- Folic Acid antagonist use (e.g. Methotrexate)
- Prior delivery complicated by Folic Acid Deficiency associated birth defect
- Cleft Palate
- Congenital Heart Disease
- Limb defect
- Urinary tract anomaly
- Hydrocephalus
- Signs: Deficiency
- See Folic Acid Deficiency
- Pharmacokinetics
- Folate in supplements twice as bioavailable as food
- Efficacy: Pregnancy
- At conception, reduces Neural Tube Defects by 50%
- Spina bifida
- Anencephaly
- Czeizel (1992) N Engl J Med 327:1832 [PubMed]
- Reduced fetal risk of Cleft Lip and Palate by 25-50%
- Lancet (1995) 346:393 [PubMed]
- Reduces Conotruncal heart defects by 43%
- Transposition of the Great Vessels
- Tetralogy of Fallot
- Botto (1996) Pediatrics 98:911-7 [PubMed]
- Efficacy: Coronary Artery Disease
- Possible Protective against cardiovascular disease
- Low intake associated with higher Homocysteine levels
- Higher Homocysteine levels associated with CAD, CVA
- References
- Boushey (1995) JAMA 274:1049 [PubMed]
- Malinow (1998) N Engl J Med 338:1009 [PubMed]
- References
- Johnson (2006) MMWR Recomm Rep 55(RR-6): 1-23 [PubMed]
- Wilson (2003) J Obstet Gynaecol Can 25(11):959-73 [PubMed]