Pregnancy and folic acid: a prevention success story


This article first appeared in the April/May 2016 issue of Your Pregnancy magazine. 

In October 2015, the American Journal of Medical Genetics carried a cover story about folic acid, while researchers gathered in Texas for the International Conference on Neural Tube Defects to coincide with the 25th anniversary of the USA’s Nutrition Labeling and Education Act, a law that led to the mandatory enrichment of certain foods with folic acid. (In South Africa, all bread and maize is fortified with vitamins and minerals, including folic acid.) 

What’s folic acid, and why is it so important?

Folate is a B vitamin (B9) found naturally in leafy green vegetables, such as asparagus and broccoli, in liver and kidney, nuts, lentils and seeds, and oranges. All the B vitamins are water soluble, which means your body doesn’t store them – so you have to top up your B9 levels every day. It’s not uncommon for people to have low levels of folate in their systems. 

Folic acid is the synthetic form of the vitamin. Vitamin B9 is essential for proper brain function and plays an important role in mental and emotional health. It’s also crucial for various bodily functions, such as synthesising and repairing DNA, cellular growth and the production of new proteins. And it’s essential for erythropoiesis, the process of making red blood cells.

Folic acid is critically important very early in pregnancy (in the first 28 days), when the brain and spine of the baby are developing. Although the exact cause of so-called ‘neural-tube defects’ isn’t known, if the fluid surrounding developing brain and spine lacks folate, birth defects can occur. 

What are neural-tube defects?

The most common neural-tube defect is spina bifida, where the spinal cord isn’t properly formed; usually, there’s a visible lump or opening on a portion of the spine. Because the spine is damaged, messages from the brain don’t get down to the lower part of the body, and this results in a loss of sensation, bladder and bowel control problems, and mobility difficulties. 

Spina bifida occurs in South Africa in 1 in 500 to 800 births, and it affects more females than males. 

Two other forms of neural-tube defect are anencephaly, when a baby's skull is not completely formed; and encephalocele, where the baby's brain and membrane push through a defect in the skull. 

Make folic acid part of your pregnancy plan

The neural tube, which is the hollow structure from which the brain and spinal cord form, closes by 28 days of gestation, which is before many women even realise they’re pregnant – which is why it’s important that all women of childbearing age should ensure they’re getting plenty of folic acid every day.

“It’s advisable that women planning pregnancy should commence folic acid prior to conception,” says Johannesburg gynaecologist Dr Kiran Kalian. “Taking 4-5mg of folic acid daily, both before and after conception, reduces spinal defects in babies by almost 70 percent, as evidenced by good studies.”

Dr Kalian adds, “Even though fortified food exists in South Africa, most obstetricians would still recommend folic-acid supplementation.”

Dr Soha Said, a consultant obstetrician at Corniche Hospital in Abu Dhabi, United Arab Emirates, concurs, advising women to begin taking folic acid a month before they conceive and to continue for the first three months of pregnancy. High-risk patients, such as those who are on anti-seizure medication or who are obese, need to take folic acid throughout their pregnancy.

Where’s the folic acid?

There was a shortage of folic acid (among other supplements) in some provinces of South Africa in November 2015, including Gauteng and the Eastern Cape, as reported by women attending clinics in these regions. But National Department of Health spokesperson Joe Maila denied that there were any shortages. 

Civil society-coalition Stop the Stock-Outs has logged months-long shortages of vitamin B complex, ferrous sulphate and folic acid in the Eastern Cape, as well as shortages of vitamin B complex in KwaZulu-Natal. 

According to Stop the Stock-Outs project manager Bella Hwang, global shortages of the raw materials used to make folic acid have pushed up the supplement’s cost, making it impossible for drug manufacturers to produce it at tendered prices. 

For more info: 

Is there a shortage of folic acid in your area?

Please report it at 084 855 7867 or

Magic beans

Researchers from Brazil and Mexico are developing a pinto bean, the folic acid of which is nearly 84 times higher than that of conventional beans.

The genetically modified beans have the added advantage that once cooked, they retain high levels of the vitamin – 328 micrograms versus 81 micrograms in regular beans.

  • For more info on The Association for Spina Bifida and Hydrocephalus South Africa, visit

Do you have a question about your pregnancy health that you'd like an expert's feedback on? Email to and we may publish your question along with advice from a specialist. Please note that we cannot supply personalised advice.

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