2 mg of folic acid to prevent PTL?

takmjs

I saw my MFM for a pre-pregnancy consultation a few weeks ago, and he gave me a prescription for folic acid. I told him it was already in my multivitamin (400 mcg), and then I'll take an extra 400 mcg as soon as I find out I'm pregnant. He said to start taking this 2 mg dosage right away (2000 mcg), before I'm pregnant, because there's been a study that showed it reduced preterm labor rates (which I had last pg). I think he said its based on a recent study, and he doesn't usually base his decisions on one study, but this seemed impressive to him and too much folic acid won't do any damage even if the study is not correct about reducing PTL. Just curious if anyone else's MFM has prescribed this higher dose of folic acid? Or heard about any studies about it from your MFM or from your own research? I'm not worried, and it'll be hard to know if it does anything, because I'll have a preventative cerclage and p17 shots too.

kneenah1231

I don't take it but I know someone who does. Your are right you wouldn't know if it helped because the 17p shot but it isn't going to harm you if you don't take it. Like pp said best time to start it is before pregnancy. I was actually on prenatal about a yr before I concieved...

DahliaFlower

I take high dose L-methyfolate for MTHFR and history of baby with CHD.  I have not heard about taking folic acid to prevent PTL, but I do think that 400-800 mcg is not nearly enough in terms of daily recommendation for intake, so if I were you, I would take the 2 mg regardless. 

My MFM did have me take about 2 G daily of calcium, which apparently also reduces risk of PTL,abruption, pre-eclampsia, etc.  I take a liquid filled capsule for good absorption.  He said dairy products were not sufficient.  

takmjs

@ATK1981, I'm curious where you're getting your info that 1 mg is the minimum? I just checked on the march of dimes website and on the bump, and they both said take 400 mcg if you're of childbearing age, 600 when you're actually pregnant. https://www.marchofdimes.com/pregnancy/folic-acid.aspx I've been taking the 400 since TTC last time, which was 3 years ago. Like I said before, once I found out I was pg last time, I took another folic acid (400 mcg).

DahliaFlower

AMK1981 said:

@ATK1981, I'm curious where you're getting your info that 1 mg is the minimum? I just checked on the march of dimes website and on the bump, and they both said take 400 mcg if you're of childbearing age, 600 when you're actually pregnant. https://www.marchofdimes.com/pregnancy/folic-acid.aspx I've been taking the 400 since TTC last time, which was 3 years ago. Like I said before, once I found out I was pg last time, I took another folic acid (400 mcg).

It's what I've been told by my family doc as well as my OB. Maybe it's because I am high risk. I agree 400 is perfectly normal for women of child bearing age. Once TTC I was told to up the dose to 2mg. As you mentioned, the extra is no harm so it seems worth it may have a benefit.

Any MFM doc will tell you to take more than the current recommendation.  The problem with the current recommendation is that the vast majority of women with MTHFR have not been diagnosed, and therefore may have inadequate folate intake relative to their metabolism.  Is it really worth subjecting your baby to a neural tube defect or heart defect?  I think not!  I didn't know I needed it until after my first daughter died as a result of CHD, because I had never been worked up for MTHFR.  I have triple variant, which means three of the mutant alleles, very rare.  Never would have known.  

AlisonandMark

I'm not sure if this will help you but I'm taking 6 mg of Folic Acid daily.  I was on 5 mg while trying to get pregnant and now I'm taking 6 mg.  I am Type 1 diabetic and my healthcare team says they always put Type 1's on at least 5 mg.  I know this is not the same issue as you have but if you're just worried about taking the 2 mg, my thoughts are that you'll be fine with it if that's what the doctor recommends.

There is also a study underway at my hospital about the link between high doses of Folic Acid and lowering the risk of pre-eclampsia.

So far everything with me and the baby is fine.

syoung0413

I take 3 mg daily + my prenatal vit.  My RE said you can not take too much.  Whatever your body does not need will spill into your urine.

AlisonandMark

@AMK1981

Yes, they said it was more for preventing neural tube defects.  They originally had me on 5 mg but said it's ok to take that much plus the extra 1 mg that is in my prenatal vitamin.  I had expected though that after the first tri they would have had me on a lower dose (because I understand that's past the point where they worry about neural tube defects) but nope, they want me on it for the full pregnancy... they are terrible at explaining "why", even though I want to know why they do things, and I am competent with medial terminology and all that, they just never take the time to explain why they're doing this or that.

So if there is a benefit later in pregnancy for this high dose, they haven't made that clear to me.

DahliaFlower

@AlisonandMark

Think of it this way, folate is essential to normal DNA replication and cellular processes.  If a woman has inadequate levels or is not metabolizing folic acid normally, there may be a relative deficiency.  As you can imagine, while the 1st tri is most important, esp in terms of formation of the heart, spine, etc., baby is making lots of new cells the whole gestation.  

If you are interested in knowing more, you can look at the biochemistry of the folate metabolic pathway.  

AlisonandMark

@DahliaFlower

Thanks!  That makes a lot of sense

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Stephanie2167

I take 2mg a day on top of what's in my Prenatal (800mcg). I'm expecting twins. They didn't say it was to prevent PTL but just because I was pregnant with twins.