Folic acid Pregnancy and Breastfeeding Warnings
Folic acid Pregnancy Warnings
Folic acid has been assigned to pregnancy category A by the FDA. During pregnancy, folic acid is usually used for the treatment of megaloblastic anemia. Folic acid requirements are increased during pregnancy, and deficiency may result in fetal harm. Studies involving pregnant women have failed to reveal evidence that folic acid increases the risk of fetal abnormalities if administered during pregnancy. Folic acid should only be used during pregnancy if clearly needed.
The recommended daily allowance of folic acid during pregnancy is 400 to 800 mcg/day. Some experts recommend daily doses of 1 mg for twin pregnancies. The Centers of Disease Control (CDC) in the US have recommended 4 mg/day of folic acid at least 4 weeks BEFORE conception through the first 3 months of pregnancy for women who have had an infant or fetus with a neural tube defect and 400 mcg/day for all women of childbearing age. Interestingly, neonates with normal serum folate concentrations have been born to folate-deficient mothers. It appears that the fetus can extract folate from maternal plasma, convert folate to a form that is not available for reverse transfer, and use it for its own advantage. Dietary folic acid is available from green leaves, such as asparagus, broccoli, spinach, and lettuce--each of which contains greater than 1 mg folic acid per 100 grams dry weight. Excessive cooking can remove or destroy the food content of folate.
Folic acid Breastfeeding Warnings
In one study, lactating mothers were given 1 mg of folic acid per day. There were significant correlations between the maternal and infant plasma and RBC folate concentrations. The average maternal plasma folic acid concentration was 5.9 ng/mL, which correlated with an average milk folic acid level of 141.4 ng/mL and an average infant plasma folic acid concentration of 29 ng/mL. The calculated total intake of folic acid by nursing infants was 14 to 25 mcg/kg/day. Colostrum is relatively low in folate, but milk folate increases as lactation proceeds. Folate levels in breast-fed infants are significantly higher than in the mothers.
Folic acid is actively excreted into human milk. No adverse effects in nursing infants have been associated with the use of folic acid during lactation. Folic acid is considered compatible with breast-feeding by the American Academy of Pediatrics. The recommended maternal daily allowance of folic acid during lactation is 500 mcg. Supplementation is not typically needed in mothers with good nutritional habits.
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