Vitamins, Birth Control Pills and the Prevention of Neural Tube Defect Diseases

Gynos have been telling their patients to take folic acid, not just one dose, but daily, so a new way to get your folic acid in: taking birth control pills! The birth control pills Yasmin and Yaz have now added folic acid and thus become Safryal and Beyaz. Although folic acid and derivatives have been associated with lowering cardiovascular disease (CVD) risk in adults, we still caution use of OCs by those over 35 who smoke, or in any women with pre-existing risk factors for strokes or other cardiovascular disease, just a bit of folic acid is not going to combat all woes for the adult female! But the extra folic acid is important for a potential developing pregnancy. Folic acid supplementation will decrease the risk of what we call neural tube defects (spina bifida is one example), decrease the incidence of lip and palate abnormalities, as well as prevent fetal heart defects. And a new study published in the Feb 13th 2013 JAMA showed that there was an association of folic acid deficiency during pregnancy and higher rates of autism. The CDC has long recommended that women from 15 to 45 (the 'reproductive years') all be on folic acid supplementation.
In many cases diet intake of folic acid is enough. But in some cases people have the genetic disorder MTHFR disease and are unable to really get their folic acid levels and the related compounds high enough by diet alone. This disorder is available by testing. Women with this disorder are not just at risk for folic acid deficiency, but at risk for miscarriages, stillbirths, strokes, and heart disease as well. So it is a genetic test that is worth getting as there are treatments for the disorders it causes.
On Dec 21st, 2010, the  The US Food and Drug Administration (FDA) has approved an oral contraceptive called Safyral has 451 μg levomefolate calcium has also been added to each tablet of a 21/7 drospirenone 3 mg/estradiol 30 μg regimen ( like the hormone combination in Yasmin; Bayer or it's generic equivalents).
The FDA had  already given the green light to Beyaz which is 24/4 folate-boosted regimen with 20 μg estrogen per active tablet (the same hormones as in Yaz; Bayer). Women of reproductive years: 15 to 45 are all encouraged to take the amount of folic acid known to reduce the risk of neural tube defects, and folic acid supplements are recommended by USPTF. Other organizations also recommend folic acid supplements: In 2003 in their practice bulletin, the American College of Obstetrics and Gynecology recommended periconceptual use of a multivitamin supplement containing 0.4 mg of folic acid for most women of childbearing potential.The American Academy of Family Physicians strongly recommends prescribing folic acid supplementation of 0.4 to 0.8 mg/day for women planning to become pregnant and without a history of neural tube defects, and 0.4 mg/day of folate supplementation to women of childbearing age who are not planning pregnancy. If a woman has had a birth defect with a neural tube defect before (spina bifida or anencephaly), the recommendation is 4 mg/day or ten times the amount the average woman is supposed to get.


The two most common neural tube (NTDs) defects in the United State are spina bifida and anencephaly and approximately 4000 pregnancies each year are affected by these serious birth defects . These pill formulas are intended to reduce the risk for rare neural tube defects in a pregnancy conceived during its use or shortly after stopping pill use. The study showed that by about 6 cycles of use the blood levels of this important B vitamin were increased. Other folate-fortified foods do exist, and many women may already be taking a multivitamin that has this amount of folate, but many women do not have adequate folate in their diet. The complete mechanism by which some women are susceptible and others protected isn't really understood. Some people may actually have a defect in their genetic make up that leads to low blood levels, or the developing fetus may have a genetic defect that makes their levels, gleaned from the maternal blood stream low.

Other co-factors in pregnancy may contribute to neural tube defects in a given pregnancy. Thirty years ago research suggested that high maternal fevers in the critical first trimester may be a contributing factor. In fact this is one reason for worrying about hot tub exposure in that time as well. It is really the core temperature that affects the fetus the most, and women can heat to feverish levels in hot tubes if they aren't careful. The neural tube closes at about the 4th week of pregnancy, so only two weeks after you miss your period. For women on the birth control pill, early pregnancy failures are more commonly missed and a source of exposure to risks like too low a folic acid intake that were unintended. Thus birth control pill supplementation is more critical.Vegans are at risk for B12 and riboflavin deficiency but low folate is not typically a risk of vegetarian diets in general.

Like other birth control pills these new pills have potential PMS, headaches, breast soreness and nausea and vomiting, and irregular bleeding, are the most common side effects.  So when you line up your vitamins today,or if you are a regular skipper of vitamins, ask your gyno if you should have folic acid in your birth control pills!

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