Pregnancy is one of the most exciting moments in a woman's life and it's a time when she needs to pay attention to everything - such as nutrition - that can affect the development of the young life inside her.

From the very early stages of pregnancy, the nutritional needs of the expectant mother change, less in terms of calories and more in terms of vitamins and minerals that the fetus also needs during this period. One of the most important things to take, especially at the beginning and even before conception, is folic acid. It's best to take this in its active form (vitamin B9), which is natural and immediately bioavailable, and is essential for the healthy development of the central nervous system of the fetus. In order for the bodies of the mother and child to accurately use active folate, it's important to properly integrate other vitamins and minerals (micronutrients), such as Vitamin B6, Vitamin B12, Vitamin C, Vitamin A and vitamin D. Important minerals include Zinc, Calcium, Magnesium and Iodine. Iron supplementation is also very important. This need increases during pregnancy, but the quantity introduced by daily diet alone may not be sufficient and may result in deficiency. Always ask your gynecologist for advice before buying a supplement.

Making sure to properly integrate the most essential micronutrients during this delicate period goes hand in hand with paying greater attention to food quality. Be careful what you choose: your baby's health also depends on what you bring to the table. It is often pregnancy that makes a woman more aware of her present and future food choices. This is the right opportunity for you too!

Folic acid and folate have been recognized as essential for the prevention of some fetal birth defects. This is why supplementation, especially with active folic acid, is very important during pregnancy. Suboptimal folate levels in the very early stages of pregnancy (especially the first 28 days) significantly increase the risk of developing fetal defects, particularly neural tube defects (NTD) such as spina bifida or anencephaly. Furthermore, folate appears to have an unclear role in the prevention of other birth defects, such as cleft lip and palate and certain heart defects.

The particular needs of the fetus lead to an increased need for folate, and suboptimal levels of it can give rise to intrauterine growth retardation, placenta previa (i.e. the placenta grows at the bottom of the uterus near the cervix) and premature birth. Since folate is involved in homocysteine amino acid metabolism, folate deficiency during pregnancy has been associated with increased blood pressure or pre-eclampsia. Pre-eclampsia (or gestosis) is a disease that can develop during pregnancy. This condition is characterized by an excessive rise in blood pressure (hypertension), often associated with a significant increase in protein in the urine (elevated proteinuria).

Why is supplementation with active folate (5-MTHF) recommended? Because it is in a form that is already active and thus equivalent to the natural one, it has increased bioavailability and is more easily incorporated by both the future mother and the fetus, which contributes to the growth of tissues during pregnancy. When used in combination with vitamins D and B12 and with minerals Iron and Zinc, active folic acid helps to promote normal cell division.

Daily supplementation of 400 micrograms (mcg) of active folic acid in women of childbearing age for at least one month before and up to three months after conception increases maternal reserves of folate.

Active folic acid is effective in preventing the risk of pregnancy pathologies and is the main form of folate that crosses the placenta; it is present in maternal blood and in the umbilical cord blood that nourishes the fetus.

Folate intake throughout pregnancy also appears to have potential beneficial effects against important maternal and fetal pathologies, such as miscarriage, reduced fetal growth, placental abruption and preeclampsia. The basic mechanism that seems to unite these pathologies, or be at least one of the causes, is an excess of homocysteine, an amino acid that must be reduced to increase the supply of folate. The plasma level of homocysteine, which can be evaluated with a blood test, is always inversely correlated to the supply of folate (vitamin B9), and therefore represents an important indicator of the levels of vitamin B9 present.

A pregnant woman's diet does not differ much from that of a normal diet, but it must adapt to an increased need for some nutrients, such as folate, to guarantee the regular, healthy development of the central nervous system and more for the fetus.

Both national and international guidelines recommend supplementation with 400 micrograms (mcg) per day of active folic acid (5-MTHF) in women without specific risk factors in order to reach an optimal concentration for the prevention of pregnancy pathologies and birth defects related to folate deficiency at this particular stage of life.

Optimal supplementation should begin at least one month before conception to get your body in the best condition for the start of pregnancy. Folate is essential, especially in the very early stages of gestation, so supplementation is essential at least until the end of the first trimester (periconceptional period).

It has been confirmed for some time that folates are essential micronutrients even before conception as they prevent the risk of birth defects related to non-closure of the fetal neural tube.
Adequate folate supplementation before planning a pregnancy increases the chances of a successful pregnancy and good fetal health.

As recommended by the Italian Network for Folic Acid Promotion, women of childbearing age who anticipate or do not exclude pregnancy should take an additional 400 micrograms per day (0.4 mg/day) of vitamin B9 starting at least 1 month before conception and up to the third month of pregnancy (periconceptional period).

Folate has been shown to have a beneficial effect on ovarian function, although the exact mechanism has yet to be identified.

Several studies have shown the importance of the proportion of folate and homocysteine amino acid concentrations in the maturing microenvironment of the oocyte (female reproductive cell), i.e., in the follicular fluid.
An excess of homocysteine and/or a lack of folic acid could in fact compromise the adequate maturation of the oocyte and the correct development of the embryo (embryogenesis). It has also been shown that folate and homocysteine are present in the follicular fluid (liquid that surrounds the oocyte during its maturation phase) as a proportion in circulating blood levels.

Folate also contributes to the reduction of homocysteine concentration via a methionine remethylation reaction (displacement of a methyl -CH₃ group from one molecule to another). The lack of folate thus leads to an increase in the concentration of homocysteine. High concentrations of homocysteine in the follicular fluid can be detrimental to the quality and maturation of the oocyte, with a consequent negative impact on embryo fertilization, implantation and development. The microenvironment of the maturing oocyte is thus positively influenced by folate.

Some research has found that 50% of women/couples face pregnancy unprepared, without adequate information on possible adverse pregnancy outcomes and how to prevent them. But they can be prevented. Just think about it in advance and talk about it in time with your gynecologist and/or family doctor. Some couples also schedule one or more visits with a geneticist or neonatologist, sometimes based on their family history. This involves doing what is now called preconception counseling, which enables women to get themselves in the best condition to experience a pregnancy without risk. It also involves thinking about proper supplementation of micronutrients (vitamins and minerals) during the right periods and using the right methods. A child is far too important to not prepare in the best way possible - thinking about it in advance! So what happens if you didn't do that? Always keep in mind that doing it sooner is better, especially in the first three months of pregnancy.