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Folic acid Pregnancy and Breastfeeding Warnings

Folic acid is also known as: FA-8, Folacin-800, Folvite

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.

See references

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.

See references

References for pregnancy information

  1. Pritchard JA, Scott DE, Whalley PJ "Maternal folate deficiency and pregnancy wastage. IV. Effects of folic acid supplements, anticonvulsants, and oral contraceptives." Am J Obstet Gynecol 109 (1971): 341-6
  2. Dawson DW "Microdoses of folic acid in pregnancy." J Obstet Gynaecol Br Commonw 73 (1966): 44-8
  3. Swinhoe DJ, Maclean AB, Gibson BE "Iron and folate supplements during pregnancy." BMJ 298 (1989): 118-9
  4. Hibbard BM, Hibbard ED, Jeffcoate TN "Folic acid and reproduction." Acta Obstet Gynecol Scand 44 (1965): 375-400
  5. Willett WC "Folic acid and neural tube defect: can't we come to closure?" Am J Public Health 82 (1992): 666-8
  6. Rolschau J, Date J, Kristoffersen K "Folic acid supplement and intrauterine growth." Acta Obstet Gynecol Scand 58 (1979): 343-6
  7. Hibbard BM, Hibbard ED "The prophylaxis of folate deficiency in pregnancy." Acta Obstet Gynecol Scand 48 (1969): 339-48
  8. Kitay DZ "Folic acid and reproduction." Clin Obstet Gynecol 22 (1979): 809-17
  9. Horn E "Iron and folate supplements during pregnancy: supplementing everyone treats those at risk and is cost effective." BMJ 297 (1988): 1325,1327
  10. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ "''Folate before pregnancy'': the impact on women and health professionals of a population-based health promotion campaign in South Australia." Med J Australia 174 (2001): 631-6
  11. Tamura T, Goldenberg RL, Freeberg LE, Cliver SP, Cutter GR, Hoffman HJ "Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome." Am J Clin Nutr 56 (1992): 365-70
  12. Cooper BA, Cantlie GS, Brunton L "The case for folic acid supplements during pregnancy." Am J Clin Nutr 23 (1970): 848-54
  13. Dansky LV, Rosenblatt DS, Andermann E "Mechanisms of teratogenesis: folic acid and antiepileptic therapy." Neurology 42(4 Suppl) (1992): 32-42
  14. Lind T "Nutrient requirements during pregnancy--I." Am J Clin Nutr 34 Suppl 4 (1981): 669-78
  15. Department of Health and Human Services, Food and Drug Administration "Food labeling: health claims and label statements; folate and neural tube defects." Fed Regist 61 (1996): 8752-80
  16. Alperin JB, Haggard ME, McGanity WJ "Folic acid, pregnancy, and abruptio placentae." Am J Clin Nutr 22 (1969): 1354-61
  17. Girling JC, Shennan AH "Epilepsy and pregnancy. Emphasise the importance of extra folate." BMJ 307 (1993): 937
  18. Department of Health and Human Services, Food and Drug Administration "Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid." Fed Regist 61 (1996): 8781-97
  19. Rush D "Periconceptional folate and neural tube defect." Am J Clin Nutr 59(2 Suppl) (1994): s511-515dic. 515-516
  20. Kitay DZ "Folic acid in pregnancy." JAMA 204 (1968): 79
  21. Pippard MJ, Chanarin I "Iron and folate supplements during pregnancy." BMJ 297 (1988): 1611
  22. Rothman D "Folic acid in pregnancy." Am J Obstet Gynecol 108 (1970): 149-75
  23. Wise J "Neural tube defects decline in US after folic acid is added to flour." Br Med J 322 (2001): 1510
  24. Hibbard BM, Hibbard ED "The treatment of folate deficiency in pregnancy." Acta Obstet Gynecol Scand 48 (1969): 349-56
  25. Berkowitz R, Coustan D, Mochizuki T. "Handbook for Prescribing Medications During Pregnancy. 2nd ed." Boston, MA: Little, Brown, and Company (1986): 242

References for breastfeeding information

  1. Tamura T, Yoshimura Y, Arakawa T "Human milk folate and folate status in lactating mothers and their infants." Am J Clin Nutr 33 (1980): 193-7
  2. O'Connor DL, Tamura T, Picciano MF "Pteroylpolyglutamates in human milk." Am J Clin Nutr 53 (1991): 930-4
  3. Jathar VS, Kamath SA, Parikh MN, Rege DV, Satoskar RS "Maternal milk and serum vitamin B12, folic acid, and protein levels in Indian subjects." Arch Dis Child 45 (1970): 236-41
  4. Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50
  5. Cooperman JM, Lopez R "Pteroylglutamates in human milk." Am J Clin Nutr 54 (1991): 760-2
  6. Cooperman JM, Dweck HS, Newman LJ, Garbarino C, Lopez R "The folate in human milk." Am J Clin Nutr 36 (1982): 576-80
  7. Cooperman JM "Folates in human milk." Am J Clin Nutr 46 (1987): 863

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