Jan 12, 2018 in Medicine

Nursing

Introduction

Mary Sparks is 35 years old. She was in her sixteenth week of pregnancy when she started visiting her physician (nurse) for her prenatal care. She received direction on several instances on the need to increase uptake of foods that contain a lot of folic acid in order to secure the healthy growth of her baby. However, she did not add any supplements to her diet but took foods to take foods with folic acid. Recently, during a routine screening the results revealed that the was a possibility of the occurrence of a neural tube defect and she might develop other complications in her pregnancy. The first question the nurse asked is, "did you take foods that contain folic acid or a supplement that has folic acid in the first month?' the lady got very scared because she did not take such supplements. Afraid for the health of her unborn child, she has become very nervous and she has started to eat a lot of foods with folic acid, all at once. Could this have an effect to her unborn child and help the suspected condition?

Research shows folic acid is important in the formation of the spinal cord in the fetus. The development of the neural tube takes place in the first month of pregnancy. Therefore, the women should be advised to increase the uptake of folic acid and supplements during this time. There are studies that have been carried out to verify the connection between folic acid uptake in pregnant women and the occurrence of neural tube defects. The studies also reveal the kind of foods that are rich in folic acid and the recommended amounts that the childbearing women should take. 

Though folic acid may help prevent neural tube defects , there are cases whereby the defects may result due to other causes such as genetics.

Survey by the US Center for Disease Control

A new survey funded by the U.S. Centers for Disease Control and Prevention, revealed only 11% of women of child bearing age is aware folic acid should be consumed prior to the start of pregnancy. Less than forty per cent of the respondents take multivitamins that contain folic acid. The lack of awareness continues to affect pregnant women even with increased awareness campaigns.

Birth defects of the brain and the spine that is the neural tube defects such as spinal bifida occur in the first trimester. Folic acid plays an important role in controlling these defects. Folic acid is required in the development of the spine cord in the first month of the pregnancy. In most cases the women are unaware that they are pregnant at this early stage.  Women are reminded to take the folic acid before their pregnancy and then continue taking it as their pregnancy progresses (Eating Foods Enriched in Folic Acid Before Pregnancy May Help Prevent     Birth Defects, 2013).

Most women know it is important to take a well-balanced diet during pregnancy but it is also important to eat healthy diet in the pre-pregnancy stage. The lifestyle maintained by the women affects the health of the baby born therefore women is advised to maintain a healthy lifestyle.

The  survey recommended 400micrograms of folic daily in before the pregnancy and continuing to the early months.  Fortified  and enriched flour  is an important source of folic acid. The amount of folic acid found in fortified  grain products is higher than the amount found in whole grain products.

Sources from grains food foundation state neural tube defects declined by 26% in 2008, ten years after the commencement of folic acid fortification of flour.

A study to determine the associations between neural tube defects and maternal folate intake among pregnancies since fortification gave the following results.  The participants reported their use of multivitamin, single- component vitamin and prenatal vitamin. Their use was measured in monthly units starting from three months before pregnancy and throughout the pregnancy. They distinguished the respondents who used folic acid supplements in during the closure and development of the neural tube into three groups.  These groups include those who used supplements 3 months before through the first month, then those who used in the first month and lastly those who did not use the supplements.

The study did not find enough evidence to form an association between maternal use of folic acid supplement and occurrence of neural tube defects. The use of folic acid supplements was similar among women with neural tube defect pregnancies and the women whose pregnancies were unaffected by the neural tube defects.  The study did not find evidence to support an association between occurrence of neural tube defects and the dietary intake of folic acid.

They advanced several hypotheses to explain these findings.  One reason is that the child bearing population has probably reached a level where all neural tube defects sensitive to folic acid can be prevented.  The study speculates most women in the study had intake of folic acid that was sufficient to protect the fetuses from folic acid-responsive neural tube defects.

Another reason cited could be errors in reporting. The results relied on maternal recall of dietary intake and supplements use, thus it could have been subject to potential bias. The size of the test group used in the study was small and this could limit detection of small differences. The size of the sample limited the study from exploring analyses of subgroups.

Folic Acid

Nurses and other medical practitioners always recommend folic acid to women who are willing to have a child at one time of their lives. In fact, folic acid works very well with pregnant women, and it can prevent some very serious medical conditions in the unborn children; it can also prevent these conditions even after the child has been born. According to this article, Folic Acid and Pregnancy, folic acid is a superhero. These practitioners recommend taking of a prenatal vitamin that works best when it is taken with 400mcg (micrograms) of folic acid. This will ensure a healthy growth of the baby without compromising the health of the mother (Folic Acid and Pregnancy, 2013).

The intake of folic acid should start even before a woman is pregnant. This is because birth defects tend to occur about three to four weeks of pregnancy; as such it is important for the mother to have folic in the system before this time. This means that a mother who starts taking folic acid before pregnancy stands a better chance of safeguarding her child than a mother who does not. As such, it is advisable for nurses and medical practitioners to ensure that a mother begins taking folic acid as early as practically possible (Folic Acid and Pregnancy, 2013). For instance, a study showed that women who took folic acid reduced their chances of early delivery by 50%.

All women of childbearing age should take 400 mcg of folic acid each day. If a woman takes a multivitamin, she should check to see whether it contains the recommended amount of folic acid. However, a woman can use folic acid supplements if she is uncomfortable with the folic acid. The following are the recommended dosages of folic acid for women: when one is trying to conceive, she should take 4oo mcg. In the first 3 months of pregnancy, she should take 400 mcg. The next months, 4-9, the woman should take 600 mcg and while breastfeeding, 500 mcg.

In the case of this lady, she risks to have a baby with some medical complications since she did not take the required dosages of folic acid.

Complications of Lack of Folic Acid

There are many complications that are related to the lack of folic acids in the bodies of pregnant women. Almost always, these complications are passed on to the should, and while a mother could have a relatively normal life even without taking folic acids, the child she is carrying (if pregnant) is on the receiving end. As such, mothers should take folic acid for this sake of their children.

According to this article, lack of folic acid can lead to a baby being born with a severe neural tube defect (in fact, according to this article, these chances increase by 70%). This is a defect that involves some incomplete growth of the spinal cord and brain. This  neural tube has three defects that include spina bifida, anencephaly and encephalocele (Pearl, 2011).

Spina bifida is the complication that involves an incomplete closing of the spinal column and the spinal cord. This complication can lead to a lifetime defect, and mothers should take folic acid to ensure that this does not happen. Anencephaly is a severe retardation of the brain, and the child will be mentally retarded. To avoid this, the mother should take lots of folic acid. The brain tissue can also protrude outside the skin as a result of an abnormal opening of the skull. This condition is known as encephalocele (Pearl, 2011).

From the above complications, this mother needs to seek a good medical doctor to give the baby the supplements for folic acid to ensure that the baby grows in a healthy manner.

Conclusion

All studies acknowledge the importance of folic acid in pregnant women. A number of the studies revealed many women lack adequate and relevant information that relate to dietary requirements during pregnancy. Many also do not know the recommendation of increasing folic acid intake in even before pregnancy. There is also lack of enough awareness on the role of folic acid in preventing neural tube defects. This means that the work for the nurses is cut out.

Nurses are in direct contact with the women throughout the term of their pregnancy. What to take when pregnant and when to take supplements are some of the questions nurses can help women answer in the course of their pregnancy. In the prenatal visits nurses are given a good opportunity to give nutrition advice to their patients. The nurses can work with the pregnant women to give them all the options available to them. Many women could benefit from this as information from a medical practitioner is considered credible.

It is therefore their responsibility to offer correct information to these women and in turn help prevent neural tube defects that are folic acid sensitive. Mothers should also take it as their responsibility to monitor their health before and after pregnancy. This will lessen the chances of having babies with complications, and this will be good for both the mother and children.

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