Folic Acid

Folate has multiple roles in the body, but the most important is that it helps in the synthesis of cellular DNA. Therefore, folic acid deficiency during pregnancy can be associated with certain congenital neural tube defects (spina bifida, anencephaly, encephalocele).

Folic acid deficiency is common in pregnant and breastfeeding women, people who consume alcohol, those with haemolytic anaemia, poor diet, diseases that inhibit folic acid absorption, malabsorption, and certain medications.

Folate deficiency can manifest as glossitis (red, inflamed, depapillated tongue), gastrointestinal symptoms (nausea, vomiting, abdominal pain), macrocytic anaemia, neurocognitive changes (depression, cognitive disorders), and uneven skin hyperpigmentation.

Folic acid is used in several situations, namely:

• to treat folic acid deficiency (alcoholism, intestinal absorption disorders)
• to treat macrocytic anaemia associated with deficiency
• as an adjunctive treatment in Biermer's anaemia
• preventively during pregnancy and preconception

The dose and duration of administration depend on the type of condition being treated or whether it is being administered preventively (during pregnancy and preconception).

The usual daily dose is between 5 and 15 mg of folic acid per day. It can be administered during or after main meals. Absorption is not affected by food.

For the treatment of macrocytic anaemia, treatment may take several months until the blood count returns to normal. However, it is important to identify the cause of the deficiency (alcoholism, malabsorption, atrophic gastritis).

Folic acid is extremely important during pregnancy, especially in the first months when foetal organogenesis (the period of foetal organ formation) takes place, as it is involved in cellular DNA synthesis. Folic acid deficiency during this critical period is often associated with neural tube defects (spina bifida, anencephaly, encephalocele). Therefore, doctors recommend taking folic acid both before conception (at least 3 months before pregnancy) and during the first 3 months of pregnancy.

The recommended dose during this period is 5 mg per day.

Folic acid taken before pregnancy helps prevent congenital malformations - neural tube defects. If you are infertile or have difficulty getting pregnant, folic acid does not affect ovulation. It is best to seek medical advice to determine the cause of infertility.

Although folic acid is safe to take, some very rare side effects have been reported, such as skin allergic reactions, sleep disturbances and irritability, abdominal discomfort, nausea and vomiting.

Folic acid is contraindicated in cases of hypersensitivity to folic acid or any of the excipients, in people with neoplasms except those associated with megaloblastic anaemia secondary to folic acid deficiency, and in cases of anaemia of unknown cause.

Chronic alcohol consumption is associated with folic acid deficiency, so it is best not to drink alcohol during and after treatment with folate.

Folic acid may interact with antiepileptic medication (phenobarbital, phenytoin or primidone) by decreasing the plasma concentration of both (by accelerating hepatic metabolism).

Gastric antacids reduce the absorption of folic acid in the intestine (by lowering the intestinal pH), so it is recommended to take folic acid tablets at least 2 hours before gastric antacid medication.