Preventatively speaking: avoiding birth defects
by Beth Donovan | Special to the Courier
During a pregnancy, we do everything we can to have a healthy baby; we avoid drinking alcohol, doing drugs, and using tobacco products. We eat right and take a prenatal vitamin. If we plan to become pregnant, most of us do these things in preparation while we are trying to get pregnant.
That prenatal vitamin is key to preventing a birth defect called neural tube defects. These types of birth defects have been specifically linked to low levels of folate in the pregnant person. Folate is a B vitamin (B9) and is considered a preventive medication.
Studies show that when a person takes a daily supplement of at least 400 mcg of folic acid, the synthetic form of folate, starting one month prior to the pregnancy and throughout the first trimester, the rate of neural tube defects is significantly lower than if folic acid is not taken. The supplement can be purchased over the counter.
Neural tube defects, although rare, are one of the more common congenital malformations, and are slightly more common in Hispanic persons in California. These defects occur during very early embryonic development and result in a range of serious diseases of the brain and spinal cord, like spina bifida and anencephaly. The exact role of folate on the development of the brain and spinal cord is uncertain, but having low levels during the first few weeks of pregnancy has been proven to be associated with a higher risk of abnormalities.
The U.S. Preventive Services Taskforce recommends all persons planning to or who could become pregnant take a daily supplement containing 400 to 800 mcg of folic acid. The “or who could become pregnant” part is important since about half of all pregnancies in the U.S. are unplanned. It may be too late to be helpful if you start taking the supplement until after you discover you are pregnant.
Many vegetables and a few meats contain folate. In the U.S. we began fortifying breads, cereals, cornmeal, and other grain products with folic acid almost 30 years ago. Regardless, most people do not consume enough of the nutrient daily to be of benefit during pregnancy. The National Institutes of Health has a list of foods containing folate and folic acid on their website at ods.od.nih.gov/factsheets.
There appears to be little harm associated with taking a folic acid supplement. However, it can interact with some medications. You should talk with your healthcare provider before starting any supplement, especially if you are on medication.
Buying either a prenatal vitamin or a folic acid supplement alone doesn’t have to be expensive. But, if you think about it, the state of “could become pregnant” can last a good many years and even a few dollars month can add up after years. Since folic acid is a preventive medication, your insurance should pay for it. This may mean that you need to get a prescription so that you can pick it up through your pharmacy benefit if that is the route you want to take. Another option is to take advantage of Good Neighbor Pharmacy’s free vitamin program, which offers free prenatal tablets. Claremont’s Hendricks Pharmacy, at 137 N. Harvard Ave., is a Good Neighbor Pharmacy.
The US Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines, develop recommendations for preventive screenings, medications, and counseling, and assign a grade to their recommendations. Earlier this year it reviewed and reaffirmed its previous recommendations from 2017. It assigned this recommendation to a grade A, meaning that the benefits of supplementation substantially outweighed the harms. You can download an app or go to uspreventiveservicestaskforce.org to learn which preventive screenings, medications or counseling services are recommended for you.
Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.