Running head: FOLIC ACID DEFICIENCY 1

Folic Acid Deficiency: Implications in Pregnancy

Carlie Eaves

Brigham Young University-Idaho

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Folic Acid Deficiency: Implications in Pregnancy

The pregnant woman experiences heightened nutritional needs resulting from a growing

fetus and the rapid physiological changes of her body. This often results in nutrition deficiencies,

whether those be caloric or relating to protein, vitamins, or minerals, and can cause harmful

effects on the growth and development of the fetus.

Folic Acid: Background

Folate, known in its supplementary form as folic acid, is an essential vitamin found in

many green, leafy vegetables, seeds and beans, and various fruits. Folic acid, the synthetic form

of folate, can be obtained in the form of capsules or liquid supplements. Though this vitamin is

essential for any balanced diet, it is of increased importance in the pregnant woman’s nutritional

intake. The International Journal of Childbirth Education explains that women who are

considering pregnancy should consume 400 to 800 micrograms of folic acid a day for optimal

nutritional status, however, many women do not meet this recommended amount (Tennant,

2014). This amount of dietary folic acid is recommended to women who are considering

pregnancy. Those women that have become pregnant should increase their doses slightly

according to the recommendations of their healthcare providers. Optimal folic acid consumption

is necessary to prevent abnormalities in the fetal development.

Despite an increased emphasis on the consumption of folic acid during pregnancy and the

increased push for the fortification of foods such as breakfast cereals, there are many pregnant

women who do not consume adequate amounts of folate and folic acid. Among those women

who do not meet the recommended daily folic acid intake are those of African American and

Hispanic descent. The American Journal of Public Health records that, “the rates of folate

insufficiency among Blacks and Hispanics were 12.2% and 8.1%, respectively,” (Cheng, Mistry,
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Guoying, Zuckerman, & Xiaobin, 2018, p. 800). These minority populations, especially those

living in low-income situations, have increased risk of infants with life threatening folic-acid

related defects. Factors related to these statistics include decreased availability of healthcare

providers based on physical location of minority groups, lack of prenatal care, and non-folate

promoting dietary preferences.

Growth and Development Factors

Adequate folic acid consumption throughout pregnancy results in optimal fetal growth

and development. However, when satisfactory folic acid amounts are not obtained, fetal

abnormalities can result. Abnormalities relating to decreased folic acid consumption consist of

neural tube defects, including anencephaly and spina bifida (Perry, Lowdermilk, Cashion, Alden,

Olshansky, Hockenberry, Wilson, & Rodgers, 2018). Most of the directly visible effects of

neural tube defects (such as the protruding sac in spina bifida) can be surgically corrected,

however, infants have permanent neurological defects that can include blindness, an inability to

walk, kidney failure, and more. Neurological development after birth is often slow and children

can be mildly to severely mentally handicapped. Physical growth can also be affected depending

on the nerve damage that occurred as a result of the defect and the level of the neural tube defect

along the spine. These things cause permanent defects that become apparent as the infant grows.

Interventions, therapies and treatments include prevention of the defect through thorough

prenatal care and supplementation, surgery after birth in the case of a defect, and intense physical

and occupational therapy from infancy to adulthood. Effective support, including possible

referrals to neural tube defect support groups or home health care is essential for the family

members. For children affected by neural tube defects, special education classes or specialized

educators may be necessary for optimal learning in addition to glasses for vision abnormalities
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and hearing aids for hearing impairments. Education of the family and affected child as possible

is necessary for proper decisions to be made and treatments to be implemented.

Education

Primary teaching should be preventative. Women who are not pregnant but are at risk for

becoming pregnant should be educated on the use of folic acid supplements, the purpose of them,

and how many to take. Special emphasis should be placed on dietary supplementation when

educating minorities who are at greater risk of folic acid deficiency. Mothers who are taking anti-

seizure medications are at increased risk for low plasma folate and folic acid concentrations due

to the antagonizing effects that anti-epileptic drugs have on folic acid absorption (Nanya, Wei,

Yingying, Mengqian, Han, Jie, & Dong, 2015). Other medications, such as anti-depressants, may

require adjustments to the folic acid medication dosage and should be discussed with the

healthcare provider. Educating the mother on folic acid supplements and possible medications

that will affect the dosage will enable her to provide the highest level of care for her unborn child

and prevent neural tube defects in the neonate. Secondary teaching should be focused on coping

and treatments for incidents of neural tube defects. Proper support groups and resources should

be provided to parents of children affected by these abnormalities. It is necessary to provide

thorough education on surgeries, expected outcomes for the particular infant, and lifelong

treatments and therapies in order to assuage the fears of the parents. Proper education will allow

parents to make informed decisions about treatments and provide the best care for their infants.

Conclusion

Proper education of the mother and emphasis on dietary supplementation will prevent

further incidents of neural tube defects in neonates. Focusing on minority groups while educating

will assist mothers to obtain optimal nutrition to deliver a healthy infant.

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References

Cheng, T.L., Mistry, K.B., Guoying, W., Zuckerman, B., & Xiaobin, W. (2018). Folate nutrition

status in mothers of the Boston birth cohort, sample of a US urban low-income

population. American Journal of Public Health, 108(6), 799-807. doi:

10.2105/AJPH.2018.304355

Nanya, H., Wei, X., Yingying, T., Mengqian, W., Han, J., Jie, L., & Dong, Z. (2015).

Periconceptional folic acid supplementation among pregnant women with epilepsy in a

developing country: A retrospective survey in China. Epilepsy & Behavior, 44, 27-34.

https://doi.org/10.1016/j.yebeh.2014.12.026

Perry, S. E., Lowdermilk, D. L., Cashion, K., Alden, K. R., Olshansky, E. F., Hockenberry, M.

J., Wilson, D., Rodgers, C. C. (2018). Maternal Child Nursing Care, 6th Edition.

[Elsevier]. Retrieved from https://pageburstls.elsevier.com/#/books/9780323549387/

Tennant, G.A. (2014). Nutrition and pregnancy: Folate and folic acid. International Journal of

Childbirth Education, 28(3), 25-28. Retrieved from https://eds-b-ebscohost-

com.byui.idm.oclc.org/eds/detail/detail?vid=0&sid=e220e00a-5330-4c4a-a22c-

f9cf97c547af%40sessionmgr102&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=awh&A

N=99881857