There is a substantial increase in folate requirements during pregnancy, from 400 mg Dietary Folate Equivalents in the nonpregnant state to 600 mg per day, because of increased erythropoiesis and fetal-placental growth. Increased folate intakes throughout childbearing age are recommended to prevent neural tube defects such as spina bifida and anen-cephaly, the most common birth defects, and to lower the risk of abruptio placenta. To be effective for preventing neural tube defects in women at risk for producing an infant with this condition, increased folate intakes are needed preconception and early in pregnancy. The neural tube closes by 28 days of gestation, which is before many women realize that they are pregnant. It is for this reason that increased folate intakes are recommended throughout the childbearing years. In the United States and Canada, fortification of flour with folic acid in recent years has greatly increased folate intakes and improved status in the population; prior to fortification, typical intakes of folate were only about half of the recommended amount. No adverse effects were reported in recent studies in which pregnant women consumed up to 4 mg of folic acid per day during pregnancy.
The RDA for vitamin B12 increases slightly during pregnancy to 2.6 mg/day. Vitamin B12 supplements are definitely required by pregnant women who are strict vegetarians; the vitamin is found only in animal products and the usefulness of the form of the vitamin found in algae and bacteria is not clear. An adequate intake of the vitamin during pregnancy is at least as important as the woman's vitamin B12 status at conception because the recently absorbed vitamin is more readily transported to the fetus than is the vitamin in maternal liver stores. Homocystei-nemia is emerging as a common risk factor for several abnormal pregnancy outcomes, especially for preeclampsia, birth defects, and low birth weight, although there has been little research on whether maternal vitamin B12 deficiency causes these problems. Infants born to women with low vitamin B12 intakes are at high risk of growth failure and neurobehavioral problems that emerge when the infant is a few months old and may be permanent. Although supplements containing the recommended dietary intake of the vitamin are probably adequate for pregnancy, no adverse effects of consuming higher amounts have been reported.
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