Folic Acid Deficiency and Its Impact on Baby's Development

Folic acid, also known as folate in its natural form, is a B vitamin (B9) that plays a vital role in cell division, DNA synthesis, and the formation of the neural tube in the developing embryo. The neural tube forms during the first 28 days after conception, often before many women know they are pregnant, making pre-conception and early pregnancy intake critically important.

Folic acid deficiency occurs when dietary intake of folate-rich foods and supplementation is insufficient to meet the body's increased demands during pregnancy. In India, where dietary patterns may not always provide adequate folate, this deficiency remains a significant concern. The Indian Council of Medical Research recommends that all women of reproductive age consume adequate folic acid to reduce the risk of birth defects.

Unlike many other nutrients, the body cannot store large amounts of folate, so consistent daily intake is necessary. A deficiency can develop within weeks of inadequate consumption, underscoring the importance of both dietary attention and appropriate supplementation throughout pregnancy.

The most common cause of folic acid deficiency is insufficient dietary intake. While green leafy vegetables, legumes, and fortified cereals contain folate, cooking methods prevalent in Indian kitchens, such as prolonged boiling and high-heat frying, can destroy a significant portion of this heat-sensitive vitamin. Women who consume limited fruits and raw vegetables may be at particular risk.

Certain medical conditions can impair folate absorption, including celiac disease, inflammatory bowel disease, and chronic alcohol consumption. Some medications, including certain anti-epileptic drugs and methotrexate, interfere with folate metabolism. Women carrying twins or multiple pregnancies have higher folate requirements and are more susceptible to deficiency.

Genetic variations affecting the MTHFR enzyme, which converts folic acid into its active form, can also contribute to functional folate deficiency even when intake appears adequate. If you have a family history of neural tube defects or have previously had an affected pregnancy, your doctor may recommend a higher dose of folic acid supplementation.

Folic acid deficiency can be subtle in its early stages. Fatigue, irritability, and a general sense of being unwell are common but non-specific symptoms that may overlap with normal pregnancy experiences. As the deficiency progresses, you may notice a sore or swollen tongue, mouth ulcers, and changes in skin pigmentation.

Megaloblastic anemia, a condition in which red blood cells become abnormally large and cannot function properly, can develop with prolonged folate deficiency. This type of anemia causes symptoms similar to iron deficiency anemia, including weakness, pale skin, and shortness of breath. A complete blood count and peripheral smear can help distinguish between the two conditions.

The most well-documented consequence of folic acid deficiency is the increased risk of neural tube defects (NTDs) in the baby. These birth defects affect the brain and spinal cord and include conditions such as spina bifida and anencephaly. Research consistently shows that adequate folic acid intake before and during early pregnancy can reduce the risk of NTDs by up to 70%.

Beyond neural tube defects, folate deficiency has been associated with other adverse outcomes, including cleft lip and palate, certain heart defects, and preterm birth. For the mother, severe folate deficiency can lead to megaloblastic anemia, which reduces oxygen delivery to tissues and increases fatigue. There is also emerging evidence linking low folate levels to an increased risk of preeclampsia and placental complications.

The critical window for neural tube formation is the first four to six weeks of pregnancy. Since many pregnancies are unplanned, public health experts recommend that all women of childbearing age maintain adequate folate status through diet and supplementation. This is particularly relevant in Visakhapatnam, where awareness campaigns can help reach women before they conceive.

A diet rich in natural folate sources is the foundation of prevention. Excellent sources include dark green leafy vegetables such as spinach, methi (fenugreek leaves), and palak. Legumes like Bengal gram (chana), black-eyed peas (lobia), and green moong dal are also rich in folate. Citrus fruits, papayas, bananas, and avocados contribute meaningful amounts as well.

To preserve folate content, minimise prolonged cooking. Lightly steaming or sauteing greens retains more folate than boiling them for extended periods. Including fresh salads, sprouts, and raw fruits in your daily meals can boost your folate intake naturally. Fortified foods, including certain breads and cereals, are becoming more widely available in Indian markets.

Supplementation is strongly recommended for all pregnant women. Most prenatal vitamins contain 400 to 800 micrograms of folic acid, which is the standard recommended dose. Women with a history of NTDs, those on certain medications, or those carrying multiples may need higher doses as prescribed by their doctor. Ideally, folic acid supplementation should begin at least one month before conception and continue through the first trimester.

If you are planning a pregnancy, consult your gynaecologist or obstetrician in Visakhapatnam about starting folic acid supplementation. This conversation is especially important if you have a history of neural tube defects, are taking medications that may interfere with folate metabolism, or have a condition that affects nutrient absorption.

During pregnancy, ensure that your prenatal blood work includes a check for folate levels and red blood cell morphology. Report any symptoms such as persistent fatigue, mouth sores, or unusual weakness to your healthcare provider. Your doctor can adjust your supplementation plan based on your individual needs and medical history. Remember, folic acid is one of the most impactful interventions in prenatal care, and timely action can make a meaningful difference in your baby's development.