Folic acid and folate have been recognized as essential for the prevention of some fetal birth defects. This is why supplementation, especially with active folic acid, is very important during pregnancy. Suboptimal folate levels in the very early stages of pregnancy (especially the first 28 days) significantly increase the risk of developing fetal defects, particularly neural tube defects (NTD) such as spina bifida or anencephaly. Furthermore, folate appears to have an unclear role in the prevention of other birth defects, such as cleft lip and palate and certain heart defects.
The particular needs of the fetus lead to an increased need for folate, and suboptimal levels of it can give rise to intrauterine growth retardation, placenta previa (i.e. the placenta grows at the bottom of the uterus near the cervix) and premature birth. Since folate is involved in homocysteine amino acid metabolism, folate deficiency during pregnancy has been associated with increased blood pressure or pre-eclampsia. Pre-eclampsia (or gestosis) is a disease that can develop during pregnancy. This condition is characterized by an excessive rise in blood pressure (hypertension), often associated with a significant increase in protein in the urine (elevated proteinuria).
Why is supplementation with active folate (5-MTHF) recommended? Because it is in a form that is already active and thus equivalent to the natural one, it has increased bioavailability and is more easily incorporated by both the future mother and the fetus, which contributes to the growth of tissues during pregnancy. When used in combination with vitamins D and B12 and with minerals Iron and Zinc, active folic acid helps to promote normal cell division.
Daily supplementation of 400 micrograms (mcg) of active folic acid in women of childbearing age for at least one month before and up to three months after conception increases maternal reserves of folate.
Active folic acid is effective in preventing the risk of pregnancy pathologies and is the main form of folate that crosses the placenta; it is present in maternal blood and in the umbilical cord blood that nourishes the fetus.
Folate intake throughout pregnancy also appears to have potential beneficial effects against important maternal and fetal pathologies, such as miscarriage, reduced fetal growth, placental abruption and preeclampsia. The basic mechanism that seems to unite these pathologies, or be at least one of the causes, is an excess of homocysteine, an amino acid that must be reduced to increase the supply of folate. The plasma level of homocysteine, which can be evaluated with a blood test, is always inversely correlated to the supply of folate (vitamin B9), and therefore represents an important indicator of the levels of vitamin B9 present.
