Vitamin B9 (Folic Acid)

Vitamin B9 (Folic Acid) Claims:

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Supporting Healthy Red Blood Cell Production During Pregnancy

Vitamin B9 plays an essential role during pregnancy for several reasons. First, it aids in the production of new red blood cells, which are required in higher amounts during pregnancy as red blood cells transport oxygen through the bloodstream to the developing foetus. An adequate supply of red blood cells ensures the foetus receives sufficient oxygen for growth and development.

Folic acid aids in red blood cell production by:

• Providing building blocks for DNA synthesis. Folic acid helps provide nucleotides, which are units that make up DNA. Red blood cells need to replicate their DNA during production, so folic acid helps enable this process.
• Acting as a cofactor in biochemical reactions. Folic acid acts as a coenzyme to help catalyse biochemical reactions involved in red blood cell formation. It helps make purines and pyrimidines, which are components of DNA and RNA involved in red blood cell maturation.
• Assisting in the metabolism of amino acids. Folic acid helps metabolise the amino acids glycine and methionine. These amino acids are incorporated into hemoglobin, the protein in red blood cells that binds to oxygen.
• Reducing levels of homocysteine. High homocysteine levels can damage red blood cells, but folic acid helps lower homocysteine by metabolizing the amino acid methionine. This reduces homocysteine-related red blood cell damage.

Additionally, folic acid is essential for producing healthy red blood cells in the fetus and placenta. Adequate red blood cell production in the placenta and fetus depends on sufficient folic acid. 

Supporting Healthy Foetal Development

Folic acid supports healthy fetal development in several key ways. Firstly, it helps ensure proper cell division and DNA synthesis in rapidly dividing foetal cells. It provides building blocks like nucleotides that fetal cells need to replicate DNA and divide. This helps organs and tissues develop properly in early stages.

Folic acid helps metabolise the amino acid homocysteine, which is linked to birth defects when at high levels. By lowering homocysteine, folic acid may reduce the risk of congenital heart defects and orofacial clefts. 

Prevention of neural tube defects such as spina bifida and / or anencephaly

Folic acid helps to prevent neural tube defects like spina bifida and anencephaly by providing the necessary building blocks for proper closure of the neural tube early in pregnancy. 

During the first month after conception, the neural tube forms and closes, developing into the brain and spinal cord. This process requires rapid cell division and DNA synthesis, which rely on nucleotides provided by folic acid. 

Adequate folic acid intake before and during early pregnancy ensures that the neural tube has enough nucleotides to close properly. Failure of the neural tube to close completely results in neural tube defects, where parts of the developing spinal cord or brain remain exposed.

Spina bifida and anencephaly are two common types of neural tube defects. Spina bifida occurs when the spinal column does not fully close, resulting in deformities of the spine and spinal cord. 

Anencephaly occurs when the neural tube fails to close at the top, leaving parts of the brain and skull undeveloped. By providing the building blocks essential for proper neural tube closure, folic acid helps reduce the risk of these severe birth defects. Women who consume at least 400 micrograms of folic acid daily beginning before conception and continuing through the first trimester can lower their risk of having a baby with a neural tube defect by up to 70%.

Enhances and promotes preconception health

Folic acid helps enhance preconception health in women by supporting proper cell division and DNA synthesis, reducing the risk of birth defects and improving egg quality. 

Adequate folic acid intake before and during the beginning stages of pregnancy is especially important for promoting optimal health in the developing fetus. 

Here are some of the key ways folic acid helps promote preconception health:

• Reduces the risk of neural tube defects: As discussed earlier in the text, getting enough folic acid before and during early pregnancy can lower the risk of neural tube defects like spina bifida and anencephaly by up to 70%. This is because folic acid provides the necessary building blocks for proper closure of the neural tube during the first month after conception.
• Supports egg health: Folic acid plays a role in DNA synthesis and repair, which are important for egg quality and maturation. Folate deficiency has been linked to chromosomal abnormalities in eggs, impaired egg development and reduced egg viability. Ensuring adequate folic acid intake before conception can help optimise the quality of eggs.
• Supports healthy cell division: Folic acid helps provide the nucleotides required for cell division. During conception and the first few weeks of pregnancy, there is rapid cell division as the embryo develops. Getting enough folic acid beforehand can help support this healthy cell division and early growth.
• May reduce risk of miscarriage: Some studies have found that higher folate levels before and during early pregnancy are associated with a lower risk of miscarriage.
• Promotes overall health: Adequate folic acid from a balanced diet rich in folate-containing foods also supports overall health, energy levels and immunity. This can help optimise a woman's health even before she becomes pregnant.

Supports healthy foetal central nervous system and brain development

Folic acid helps ensure healthy development of the fetal central nervous system and brain. During early pregnancy, folic acid supports rapid cell division and growth of the neural tube which eventually forms the baby's brain and spinal cord. Inadequate folic acid during this critical time has been linked to neural tube defects like spina bifida and anencephaly. Getting enough folic acid before conception and in early pregnancy helps reduce the risks of these serious birth defects by up to 70%.

Folic acid is also needed to synthesize DNA and RNA, the genetic material required for cell division and growth. This is especially important during early pregnancy when cells are dividing rapidly to form the baby's organs and tissues. The brain and spinal cord depend on proper cell division and growth for normal development. Folic acid helps provide the genetic building blocks to support this healthy development of the fetal nervous system.

Once the neural tube has closed, folic acid continues to support brain development throughout pregnancy. It helps produce neurotransmitters like serotonin, dopamine and norepinephrine which are essential for brain function. An optimal supply of folic acid ensures that the foetus gets enough of these key chemicals to promote healthy growth of neurons and synapses in the developing brain. Studies have found that infants born to mothers with higher folate levels during pregnancy tend to have better cognitive development in early childhood.

Supporting placental health

Folic acid supports healthy placental growth and function in several ways. The placenta is an organ that forms during pregnancy to connect the mother's and foetus's blood supply. It provides nutrients and oxygen to the fetus and removes waste products. Folic acid helps:

• Support cell division and growth: Placental cells divide rapidly during early pregnancy. Folic acid provides the genetic building blocks needed for this cell proliferation through synthesising DNA and RNA.
• Promote angiogenesis: Folic acid helps stimulate the formation of new blood vessels within the placenta. This angiogenesis ensures an adequate blood supply to support the growth and nutrition needs of the foetus.
• Prevent placental abnormalities: Adequate folic acid around the time of conception may help reduce the risk of placental abnormalities like preeclampsia and placental abruption. These conditions can restrict nutrient and oxygen transport to the fetus and potentially compromise fetal growth and development.
• Optimising amino acid transport: Folic acid helps regulate the transport of amino acids - the building blocks of proteins - across the placenta. A steady supply of amino acids is required for foetal growth and organ development.
• Modulate hormone production: The placenta produces hormones that are crucial for maintaining pregnancy. Folic acid plays a role in regulating the production of these key placental hormones like progesterone, estrogen and human chorionic gonadotropin.

All of this helps to ensure the placenta can effectively nourish and sustain the development of the baby.

Folate Rich Foods

In addition to a prenatal vitamin, to ensure you have adequate folate levels, consume more folate-rich foods including:

• Dark leafy green vegetables (e.g. spinach, Brussels sprouts, kale)
• Asparagus
• Broccoli
• Citrus fruits
• Legumes (e.g. chickpeas, black beans, lentils)
• Papaya
• Seeds (especially sunflower seeds)
• Organ meats 

References:

Braun, L., & Cohen, M. (2014). Herbs & Natural Supplements – An Evidence-Based Guide. Elsevier.

Food Standards Australia New Zealand. (2017). Schedule 4 Nutrition health and related claims. Schedule 1 RDI and ESADDI. Australia Government. Federal Register of Legislation.

Haas, E. (1992). Folic Acid (Folacin / Folate). In Staying Healthy with Nutrition.

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. (1998). Introduction to Dietary Reference Intakes. In Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. National Academies Press (US).

James A. Greenberg, Stacey J. Bell, Yong Guan, & Yan-Hong Yu. (2017, April 30). Folic acid supplementation and pregnancy: more than just neural tube defect prevention. REPRODUCTIVE ENDOCRINOLOGY, 34, 57–63. https://doi.org/10.18370/2309-4117.2017.34.57-63

Jamison, J. (2003). Clinical Guide to Nutrition & Dietary Supplements in Disease Management.

Scientific Committee. (2013). Standard 1.2.7 – Nutrition, Health and Related Claims (FSANZ).

Reavley, N. (1998). The New Encyclopedia of Vitamins, Minerals, Supplements and Herbs. Bookman Press.

Marshall, N. E., Abrams, B., Barbour, L. A., Catalano, P., Christian, P., Friedman, J. E., Hay, W. W., Hernandez, T. L., Krebs, N. F., Oken, E., Purnell, J. Q., Roberts, J. M., Soltani, H., Wallace, J., & Thornburg, K. L. (2022, May). The importance of nutrition in pregnancy and lactation: lifelong consequences. American Journal of Obstetrics and Gynecology, 226(5), 607–632. https://doi.org/10.1016/j.ajog.2021.12.035

Murray, M. (1996). Encyclopedia of Nutritional Supplements. Harmony.

Gropper, S., Smith, J., & Groff, J. (2009). Advanced Nutrition and Human Metabolism (5th ed.). Wadsworth Cengage Learning.

NHMRC. (2014). Nutrient Reference Values for Australia and New Zealand. Australian Government Department of Health and Ageing. https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/folate (accessed November 28, 2023).

Saldanha, L. G., Dwyer, J. T., Haggans, C. J., Mills, J. L., & Potischman, N. (2020). Perspective: Time to Resolve Confusion on Folate Amounts, Units, and Forms in Prenatal Supplements. Advances in nutrition (Bethesda, Md.), 11(4), 753–759. https://doi.org/10.1093/advances/nmaa017

Obeid, R., Kirsch, S. H., Dilmann, S., Klein, C., Eckert, R., Geisel, J., & Herrmann, W. (2016). Folic acid causes higher prevalence of detectable unmetabolized folic acid in serum than B-complex: a randomized trial. European journal of nutrition, 55(3), 1021–1028. https://doi.org/10.1007/s00394-015-0916-z

Hekmatdoost, A., Vahid, F., Yari, Z., Sadeghi, M., Eini-Zinab, H., Lakpour, N., & Arefi, S. (2015). Methyltetrahydrofolate vs Folic Acid Supplementation in Idiopathic Recurrent Miscarriage with Respect to Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms: A Randomized Controlled Trial. PloS one, 10(12), e0143569. https://doi.org/10.1371/journal.pone.0143569

Zimmermann, M. B. (2001). Burgerstein's Handbook of nutrition: Micronutrients in the prevention and therapy of disease. Georg Thieme Verlag.