What Is Folic Acid Deficiency?
Folic acid affects the development of the neural tube, which is the structure in a developing fetus that eventually forms into the brain, spinal cord, and surrounding tissue. When a pregnant woman does not receive enough folic acid, the neural tube may fail to close. This may lead to serious health complications for the child that may even result in death.
Folic acid can be found in leafy greens, citrus fruits, and legumes, as well as enriched foods like bread, pasta, rice, or breakfast cereal. Incorporating these foods may not meet the folic acid content required for a developing fetus. Women who are planning to become pregnant are often advised to take supplements to ensure that their child receives enough of this important nutrient.
Folic Acid and Neural Tube Defects Quick Facts
- Roughly 300,000 neural tube defects occur worldwide each year.
- A developing fetus needs 400 micrograms of folic acid daily, but researchers estimate most people consume only 140 micrograms a day.
- There has been a 28% reduction in pregnancies affected by neural tube defects since it became common to enrich grains with folic acid.
Causes of Folic Acid Deficiency
Folic acid deficiency may occur if there is something blocking the absorption of the nutrient or preventing the body from converting it to a usable form.
Factors that can cause folic acid deficiency include:
- Alcohol Consumption: Drinking alcohol can prevent the proper absorption of folic acid
- Diet: Not consuming enough fresh fruits, vegetables, and legumes can put mothers and babies at risk of folic acid deficiency
- Diseases/Illnesses: Crohn’s disease, celiac, severe kidney diseases, and some forms of cancer that require dialysis can all lead to difficulty absorbing or utilizing folic acid
- Genetics: Some people are born with genetic mutations that cause the inability to absorb folic acid
- Medications: Some medications, such as those used to treat seizures, can lead to folic acid deficiency
When a woman of childbearing age begins to consider starting a family, her doctor should guide her to mitigate all possible risk factors that can lead to folic acid deficiency. Failure to do so could be considered medical negligence and can have dire consequences for both the mother and baby.
Folic Acid Deficiency Symptoms
The symptoms of folic acid deficiency vary widely in both presentation and severity. Both the mother and baby can be affected by the absence of this vital nutrient.
Pregnant women suffering from folic acid deficiency can suffer from a variety of symptoms. While these symptoms can cause significant discomfort, they are generally temporary and do not cause long-term complications.
Folic acid deficiency symptoms include:
- Decreased appetite
- Gray hair
- Low energy
- Mouth sores
- Swollen/tender tongue
The symptoms of folic acid deficiency are more severe for the child than for the mother. Improper development of the neural tube can lead to a wide variety of birth defects of the brain and spinal cord.
The two main types of neural tube defects are spina bifida and anencephaly.
Spina bifida occurs when the backbone fails to fully develop, resulting in an unprotected and exposed spinal cord. The severity of spina bifida symptoms can vary depending on the location of the opening where the spinal cord is exposed and if the nerves have been damaged.
Symptoms of spina bifida include:
- Hydrocephalus (water on the brain)
- Intellectual disability
- Lack of sensation in extremities
- Partial paralysis/limited mobility
- Skin injuries (burns, sores, calluses, blisters)
In spite of these challenges, many individuals with spina bifida go on to live full and active lives with proper support and treatment.
Anencephaly affects about 1 in 4,600 babies in the United States each year. It occurs when the top of the neural tube fails to close properly during the early stages of pregnancy. Children born with anencephaly are missing parts of the brain and skull.
There is no treatment for anencephaly, and children born with the condition generally die shortly after birth.
Can Folic Acid Deficiency Be Prevented?
Yes, folic acid deficiency is preventable. A simple blood test can determine if a woman is at risk for folic acid deficiency. Additionally, most neural tube defects can be diagnosed before birth with proper screening.
The neural tube develops in the first few weeks of pregnancy, often before the mother knows she is pregnant. The first prenatal visit generally occurs 6-12 weeks into a pregnancy. By this time, it may be too late to take preventative measures against neural tube defects.
Women of childbearing age who are interested in having children should begin taking folic acid supplements before they become pregnant.
Doctors have a duty to help their patients manage all relevant risk factors with proper testing and screening. When this duty of care is breached it can have devastating, lifelong consequences for children and families.
Folic Acid Deficiency and Medical Negligence
Pregnancy is a delicate and demanding experience, where seemingly small oversights can have big consequences. Something as simple as not being told to take the right kind of vitamins can affect both mother and baby in serious, long-term ways.