spinach - folic acidPregnant, or hoping to be? And gluten free?

Thanks to Melissa on the message-board, I’ve been made aware of this, from the British National Formulary:

Folic acid for the prevention of neural tube defects

Folic acid supplements taken before and during pregnancy can reduce the occurrence of neural tube defects. The risk of a neural tube defect occurring in a child should be assessed and folic acid given as follows:

Women at a low risk of neural tube defects should be advised to take folic acid as a medicinal or food supplement at a dose of 400 micrograms daily before conception and until week 12 of pregnancy. Women who have not been taking folic acid and who suspect they are pregnant should start at once and continue until week 12 of pregnancy.

Couples are at a high risk of conceiving a child with a neural tube defect if either partner has a neural tube defect (or either partner has a family history of neural tube defects), if they have had a previous pregnancy affected by a neural tube defect, or if the woman has coeliac disease (or other malabsorption state), diabetes mellitus, sickle-cell anaemia, or is taking antiepileptic medicines (see also section 4.8.1).

Women in the high risk group who wish to become pregnant (or who are at risk of becoming pregnant) should be advised to take folic acid 5 mg daily and continue until week 12 of pregnancy (women with sickle-cell disease should continue taking their normal dose of folic acid 5 mg daily throughout pregnancy).

I’ve put the key phrases in bold above. (The BNF is responsible for advising healthcare professionals here in the UK on medicines).

We all know that folic acid is important in pregnancy, and here in the UK, breakfast cereals are usually fortified. In the US, I understand that flour has been fortified with folic acid since 1996, though this probably doesn’t apply to gluten free flour. The Food Standards Agency here is recommending the fortification of bread flour, though there is some debate about the health risks to the general population. Quoted in the Telegraph:

Dr Sian Astley from the institute [of Food Research] said: “Fortifying UK flour with folic acid would reduce the incidence of neural tube defects (such as spina bifida).

“However, with doses of half the amount being proposed for fortification in the UK, the liver becomes saturated and unmetabolised folic acid floats around the blood stream.

“This can cause problems for people being treated for leukaemia and arthritis, women being treated for ectopic pregnancies, men with a family history of bowel cancer, people with blocked arteries being treated with a stent (an internal splint) and elderly people with poor vitamin B status.”

She said it also increased the likelihood of multiple births for women undergoing IVF treatment.

While this debate is likely to continue for a while here, the key point is that if you have coeliac disease and are trying to conceive (or are in the very early stages of pregnancy) you should be increasing your intake of folic acid. Unless you decide to live on spinach, in which case you’ll have other problems, you will need to ask your doctor for a prescription for 5g/day (here in the UK, anyway).