A question about folic acid pre-conception with a family history of spina bifida...

[bem3231]

Hi everyone -

This is my first post in this thread. I''ve just started visiting here because my new hubby and I are in the ''planning when to start trying to conceive'' phase...

Some brief history:

- We just got married July 26th. I''ll be 36 next month, he''ll be 41 next month. This will be the first try at conception for both of us.

- My mom had two sons from her first marriage when she was very young. I am the only child from her second marriage. She was 42 when she had me, however she had had a miscarriage and a still birth prior to having me.

- Her baby that was still born had spina bifida.

I asked my doctor several months ago about increased folic acid pre-conception for women with a family history of spinal canal defects. He did some research and prescribed 5 mg of folic acid per day, but said that I could start that whenever we start officially ''trying''. I''ve recently done some more research online, and what seems to be recommended is to start this higher dosing of folic acid prior to trying to conceive. I''ve read anything from one to three months (minimum) pre-conception.

Does anyone have any additional information on this? Hubby and I are conscious of the fact that we''re not getting any younger, and initially we were going to start trying right away. However, since having read this about the folic acid (and for a few other reasons that I won''t launch into - mostly due to me wanting more time to adjust to being married and to try to make a plan to spend more time together in the same city first) I''d ideally like to wait 3 - 5 months before trying to conceive. I''m stuck on wondering if the benefits of the extra months of higher folic acid dosing outweigh the detriments of waiting those extra months, given our respective ages?

Any information or advice that anyone might be able to provide would be much appreciated.

Thanks!

 

[aliciagirl]

Honestly, if I were you, I would go ahead and start taking the folic acid right away.

I found a study on Pubmed (I don''t know if you use this, but you can simply go to pubmed.com and type in "folic acid" or "folic acid + periconception" and read the studies) that said that taking folic acid from 4 weeks before conception to 12 weeks after will decrease your risk of neural tube defects by 72%. I couldn''t find find any statistics on waiting longer, but folic acid has pretty close to zero side effects, so taking it starting now wouldn''t be harmful at all.

All the studies I can find say to start using folic acid in the "periconception" period, which from what I can find means using it for a month before conceiving. Starting it earlier may not have any additional protection, but since it is so harmless, I would recommend starting it right away on the chance that it may offer some extra protection.

Maybe you could contact several OBGYN''s and ask their opinion?

 

[bem3231]

Thanks, aliciagirl. I should have added that I have, indeed, started the 5mg/daily folic acid supplementation (started yesterday). I''m moreso wondering if, given my family history of spina bifida, I should for sure do the 3 mos of pre-conception supplementation to be safe.

There are so many factors to consider...

Thanks again!

 

[MichelleCarmen]

In your situation, I would for sure take folic acid and use contraception during a three-month period to be sure that the folic acid has built up in your system before TTC. Are you taking prenatals right now? It can''t hurt to start those up too.

 

[Pandora II]

Hi Bem!

I'm currently taking 5mg a day of folic acid - I'm on an anti-epileptic (for nerve pain) which just happens to be an anti-folate. I also have a history of low folic acid levels.

I only discovered this 3 days after we had thrown the BC out the window on our wedding night and promptly started taking 13 normal folic acid tablets a day to get my levels up! The look they gave me in the chemist when I was calculating that a 3 month supply would last me about 6 days and staggering to the till with ten boxes!

My GP had said to start taking it when we started TTC, but I'm pretty happy I didn't get PG on our honeymoon as I'd be seriously worried if my levels were high enough.

I suggest to start taking the 5mg now and also get some bloods done.


Women on Lamotrigine (the med I have) should be taking 5mg of FA as a matter of course according to the research papers I read (although it's not in any of the drug manufacturer's literature which I think is pretty bad of them), so don't worry about taking the stuff for a potentially long time - I don't think you can OD on it!

 

[Dreamer_D]

I think starting to take the supplement now and waiting 2-3 months would be a good plan, and it sounds like it fits your wishes as well. ETA: I suspect that if you really want to start TTC now, then taking the supplement every day religiously will be sufficient to provide the protection you want. I am not sure it really needs so long to "build up" and they tell women to take it early to be on the safe side and to make sure it is a habit for them??

If you are on hormonal birth control, if you go off of it now (and use a barrier method instead), then that 2-3 month wait period will also give your body time to adjust to being off hormones and will let your cycles get on track. Many women's fertility returns immediately after going off hormonal birth control, but others can take longer, and with age the time for your body to adjust *can* take longer, though of course this varies from woman to woman. Since time is of the essence for you, I totally recommend that you also start charting your fertility signs now too! This will help you understand your cycles and then when its time to actually TTC, you will be really ready to get preggo in the shortest time possible (charting can seriously reduce the amount of time that it takes to get preggo since it helps you time intercourse for your most fertile time). Most of the ladies in the TTC thread/group currently chart, so that is a great place to get more information if you are interested. The book, "Taking Charge of Your Fertility" is also an amazing resource.

Feel free to ignore this advice if you prefer a more laid back appoach to TTC! I started charting to TTC and found it a wonderful tool soI suggest it to everyone!

Good luck!

 

[bem3231]

Thanks for the feedback everyone!

I did stop bcp''s last October. I''d been on them for sixteen years straight and had heard that it can take a while to ''reset'' your system. Indeed, it''s only in the past couple of months that my cycle has become at all regular. I wish that I would have gone off the pill long ago. I feel much more ''in tune'' with myself after having quit it, if that makes sense.

It seems that there''s some support for my original ideal approach - start the folic acid (and prenatals) and then start ttc in a few months.

If anyone has any additional feedback please let me know. Thanks again!

 

[Gemma12]

Bem, I am sorry I am a bit late to this thread-just wanted to let you know that there is an additional benefit to starting folic acid early in terms of a reduced risk of miscarriage. If you wanted to start trying sooner, you do need to take the higher dose every day as you already are. I''m not aware of hard core evidence that says you must have a 3 month lead in period in order for it to work to prevent NTD. One of the benefits of this is that compliance is higher (ie people are less likely to forget to take the pill). I believe in the US a lot of foods are folate supplemented (breads etc) so your body folate is likely to be higher (unless you have pernicious anaemia) if you eat those foods regularly.

HTH! Good luck-wish you all the best in TTC!

 

[happy in love]

Hi Bem,
I can only relay the advice I have received as I have no knowledge of this stuff myself, but I have a client who is a Dr. for special needs/emergency pediatrics and her advice to me was that it is best to start prenatals with plenty of folic acid (800-1000) 6 month prior to getting preggo to help prevent spina bifida among other reasons.

There is no harm in taking prenatals for longer than that either, so if it were me I'd probably start on some soom.
HTH.

 

[Independent Gal]

BEM, a great source... perhaps the best ''popular'' source of information about spina bifida is the March of Dimes. After all, this is what they do.

According to them:

"Women who already have had a baby with spina bifida or another NTD, as well as women who have spina bifida, diabetes or seizure disorders, should consult their health care providers before another pregnancy about the amount of folic acid to take. Studies have shown that taking a ten-fold larger dose of folic acid daily (4 milligrams), beginning at least one month before pregnancy and in the first trimester of pregnancy, reduces the risk of having another affected pregnancy by about 70 percent (2)."

So, if you are taking it one month prior to TTC, then even if you had already had a baby with spina bifida (which WAY increases your risk over your mother having had a baby with the disease), your chance of having a baby with neural tube problems drops to a shade over 1%. Since, in fact, you yourself have never had a baby with a nerual tube defect, the actual chance, with one month of 4mg of folic acid before TTC, is a fraction of 1%.

However, each month that you wait to try to concieve after 35 has a dramatic effect on the likelihood of other problems... The slide is gradual till our mid 30''s and then the probability of problems increases really steeply with each passing month!! Difficulty conceiving, rate of miscarriages (although your 16 years on bcp actually helps protect you there! no one knows why yet, but cool huh?), chromosomal abnormalities, serious complications, other serious birth defects, etc. increases quite a lot more than your risk of neural tube defects decreases (especially after 1 month on that super-high dose of folic acid... which is 10 times higher than the usual RDA, btw).

So, if I were you, and particularly because your chance of conceiving in the first month or two is so very slim anyway, I would hop to it.

 

[Pandora II]

Thanks for that info IG.

Very useful to know!

 

[Independent Gal]

Note that the March of Dimes also makes clear that taking that level of folic acid is ONLY advised if you have a distinctly higher risk than normal of neural tube defects. It is NOT a good idea to overdose on ANY vitamin without the explicit instructions of your doctor. And March of Dimes really emphasizes that with the folic acid. So don't all run out and get your 10x the usual dose pills unless your doctor has told you to. Even vitamins have side effects if you take enough of them.