It protects the child from serious malformations, but only a third of future mothers follow proper prevention. Thus, from the United States, comes the indication to fortify certain foods with this substance.

Today there are many women who have heard about the importance of supplementing folic acid while waiting. Too few, however, are aware of the fact that it is essential that the intake of this substance occurs at least one month before conception, if you plan to become pregnant. And, however, since not all pregnancies are planned, the updated guidelines on the subject recommend folic acid supplementation to all women of childbearing age who do not rule out pregnancy. Only in this way, in fact, is it possible to avoid up to 70% of neonatal malformations linked to neural tube defects.

It serves to prevent serious congenital anomalies

“If the future mother only starts taking folic acid after she realizes she has become pregnant, the phase of the first cell divisions, which lead to the formation of the neural tube, is now over”, explains Professor Fabio Mosca, President of the Italian Society of Neonatology (SIN). “This means that any alterations that may occur when the level of this substance is low can no longer be avoided.

“Among the most important and frequent congenital anomalies of the central nervous system, which are created during the development of the embryo due to alterations in the closure of the neural tube, there are spina bifida, that is, the failure to close the spine, with alterations in the spinal cord, anencephaly – incomplete brain development – and encephalocele, i.e. a herniation of brain and meningeal tissue”, says Professor Domenico Arduini, gynecologist, president of the Scientific Committee of ASM, the Association for the Study of Malformations.

Folic acid integration is always necessary

But what exactly is folic acid? And is it not possible to guarantee its requirements through food? “Folic acid is a water-soluble vitamin of group B”, explains Domenico Arduini. “It is found in foods such as liver, green leafy vegetables, artichokes, legumes, broccoli, cabbage, oranges and mandarins. However, food alone is not enough, for various reasons: part of folic acid, for example, can be dispersed during cooking and there is interference from other foods. In addition, the metabolism of this substance can be reduced by the intake of alcohol – in any case banned during pregnancy – and certain drugs.

It is necessary, therefore, to resort to a supplement, reimbursed by the National Health Service (on prescription). The recommended dose is generally 400 micrograms per day (maximum 500). The dosage should be reshaped in special cases, such as a twin pregnancy or previous pregnancies in which neural tube defects have been found or, again, women on therapy with drugs antagonistic to folic acid. The intake should be started at least one month – better two – before conception and then, in any case, continued throughout the pregnancy. According to recent studies, it would also be useful for men a supplementation of folic acid to reduce the risk of malformations of the child.

More information or fortified foods?

Currently, however, only 30-40% of women do the right prevention, a sign that there is not yet sufficient knowledge of this preventive strategy. “At this point, there are two options: to implement a widespread information campaign, capable of reaching the approximately 450,000 women who every year, in Italy, decided to give birth to a child, or follow the example of the United States, where since 1998 the food industry has been required by law to fortify with folic acid some foods, particularly those based on cereals,” says Professor Mosca.

“After 15 years of this policy, we have seen that the rate of malformations of the neural tube has fallen by 35%, with almost 1500 fewer cases of this type of disease. In Italy, too, a prophylactic action of this kind would be desirable. The SIN has been committed for years on this front, both to reach with information campaigns as many women and families as possible, and to raise awareness of the Ministry of Health on this issue.

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