If you require iron supplements, you can maximize the absorption of iron by taking the iron tablet with a citrus drink such as fresh orange juice, which is rich in vitamin C (also important for treating anaemia).
If you suffer from heartburn or indigestion, do not take the iron supplements at the same time as antacid medicine as this reduces the absorption of iron. In pregnancy, iron supplements are often combined with folic acid, frequently in the same tablet.
Folic acid
Folic acid is an important member of the B vitamin family and, as such, is essential in small quantities for maintaining normal body metabolism. Because folic acid does not occur naturally in your body you need to obtain it from other sources such as your food or by means of vitamin supplements.
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There is one relatively uncommon form of anaemia due to deficiency of vitamin B12. Folic acid supplements could make it difficult for routine blood tests to pick up this condition. If you have a history of anaemia due to vitamin B12 deficiency, check with your doctor before taking folic acid.
The importance of folic acid
Folic acid is essential for the production of healthy red blood cells, which carry oxygen around the body. We are constantly making and replacing our red blood cells: it has been estimated that, on average, an adult makes more than 120 million new red blood cells every minute throughout their lives. Hence deficiency of folic acid means that an insufficient number of red blood cells are produced, leading to problems such as anaemia.
Folic acid is also known to reduce the risk of certain abnormalities in the baby known as neural tube defects, of which spina bifida (which in its severe form can be seriously dangerous for the baby), is perhaps the best known. All babies are potentially at risk of spina bifida, or other neural tube defects such as hydrocephalus, whatever the mother’s age and whether or not this is a first or a subsequent pregnancy.
The neural tube is the part of the developing baby that eventually becomes the brain and the spinal cord. It forms at about four weeks after conception or about two weeks from the time of a missed period. Research has shown that sufficient folic acid in the mother’s blood is essential for normal formation of the neural tube. Interestingly, in the USA, folic acid has been added to all flour for bread and pasta from 1998. Since that time, the number of babies with neural tube defects has fallen by almost 20 per cent. There is also some evidence that suggests that adequate folic acid intake might help prevent problems such as small-for-dates babies.
Spina bifida and hydrocephalus
In babies with spina bifida there is a defect in which part of one or more vertebrae (the bones making up the spine) fails to develop completely, leaving a portion of the nervous tissue in the spinal cord exposed, which leads to damage of the nerves. This defect can occur anywhere in the baby’s spine but is most commonly seen in the lower back. The condition varies in severity and much depends on where the defect is and how much of the nervous tissue is exposed. Mild cases may have no major disability but in more severe cases, there can be paralysis of the legs, loss of sensation and incontinence due to loss of bladder control.
Women who have had a child with spina bifida are more at risk than women who have had a child without the condition. In such instances, it would be worthwhile obtaining specific pre-pregnancy advice before conceiving again, and you should consult your doctor.
Hydrocephalus is where there is an excess of fluid in chambers within the brain. This often arises because the flow of fluid through these chambers is obstructed. The excess fluid builds up in the chambers and the pressure causes them to enlarge, which can damage the brain tissue. Hydrocephalus may occur with spina bifida or on its own.
Folic acid from supplements
The ideal time to start taking folic acid supplements is two to three months before starting trying to conceive. Make it a part of pre-pregnancy planning. The tablets can
must know
Folic acid allowance
• The recommended daily allowance for adults is 200mcg, but prior to becoming pregnant it is recommended that the intake is doubled to 400mcg a day.
• Continue to take 400mcg for at least the first 12 weeks of your pregnancy.
• Some doctors are happy for you to stop while others recommend you take it throughout pregnancy – folic acid is a vitamin that can help prevent health problems such as anaemia and might help to reduce any other pregnancy complications.
be obtained from all good pharmacies. If you don’t like taking tablets, try folic acid milk, also available from pharmacies; one carton usually represents the daily requirement. Always remember to follow the instructions on the pack carefully. If you are taking prescribed medicines, check with your doctor before taking any supplements to be on the safe side.
Folic acid from food
Folic acid is soluble in water and is stored mainly in the liver. It is largely destroyed by cooking, however, so serve salads and stir-fry or steam vegetables lightly rather than boiling them. You can obtain it from:
• fresh dark green vegetables like broccoli, Brussels sprouts, peas, green beans, chick peas and spinach
• oranges
• peanuts, although salted peanuts should be avoided if possible because of the extra salt. In addition, if you or your family has a history of peanut allergy or other allergic conditions, like asthma and hay fever, it is definitely recommended that you avoid peanuts during pregnancy
• many breakfast cereals have added folic acid (read the label) and milk and yoghurt also contain it
• wholemeal and wholegrain breads are high in folic acid, as are wheatgerm, brewer’s yeast and yeast extract, so add these to your diet
Many women with a healthy diet may already have a sufficient folic acid intake for pregnancy simply from their food without the need for supplementation. But folic acid deficiency commonly arises in pregnancy due to the many extra demands the development of the baby places on the mother’s body. Even women who have an adequate diet may not be taking in sufficient amounts of folic acid because the body is not absorbing it efficiently from food.
Folic acid supplements are therefore recommended for every woman trying to conceive to be sure that her intake is sufficient. In pregnancy, the kidneys filter folic acid from the blood at four times the normal rate, which is another reason why supplements are recommended. If you decide not to take folic acid supplements, however, ensure that you have a good daily intake of folic acid in your diet by eating suitable quantities of the foods listed on the previous page.
Foods to avoid
There are certain foods that are best avoided when you are trying to conceive and also in pregnancy. This is because of the risk of infection or because they contain potential toxins.
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When storing or preparing food, remember to keep raw meat and poultry separate from cooked or pre-prepared foods and use separate utensils for them. In addition, always wash your hands thoroughly after handling raw meat and poultry.
For example: unpasteurized milk, soft cheeses and pâté can contain a type of bacteria called listeria that can cause miscarriage and premature labour; raw and uncooked cured meats (such as ham and prosciutto) and unwashed (soil-covered) vegetables may carry toxoplasma, an organism that can cause abnormalities in the baby. Liver