Folic acid is a pregnancy superhero. Taking a prenatal vitamin with the recommended 400 micrograms (mcg) of folic acid before and during pregnancy can help prevent birth defects in your baby’s brain and spinal cord. Take it every day and go ahead and have a bowl of fortified cereal, too.
What is folic acid?
Folic acid is a man-made form of a B vitamin called folate. Folate plays an important role in the production of red blood cells and helps your baby’s neural tube develop into its brain and spinal cord. The best food source of folic acid is fortified cereals. Folate is found naturally in dark green vegetables and citrus fruits.
When should I start taking folic acid?
Birth defects occur within the first 3-4 weeks of pregnancy. So it’s important to have folate in your system during those early stages when your baby’s brain and spinal cord are developing.
If you talked to your doctor when you were trying to conceive, they probably told you to start taking a prenatal vitamin with folic acid. One study showed that women who took folic acid for at least a year before getting pregnant cut their chances of delivering early by 50% or more.
The CDC recommends that you start taking folic acid every day for at least a month before you become pregnant, and every day while you are pregnant. However, the CDC also recommends that all women of childbearing age take folic acid every day. So you’d be fine to start taking it even earlier.
If you picked out your own prenatal vitamin, take it to your OB once you’re pregnant to make sure it has the recommended amounts of everything you need, including folic acid. All prenatal vitamins are not the same and some may have less or more of the vitamins and minerals you need.
How much folic acid should I take?
The recommended dose for all women of childbearing age is 400 mcg of folate each day. If you take a multivitamin every day, check to see if it has the recommended amount. If for some reason you don’t want to take a multivitamin, you can take folic acid supplements.
Here’s how much folic acid is recommended each day in terms of pregnancy:
- While you’re trying to conceive: 400 mcg
- For the first three months of pregnancy: 400 mcg
- For months four to nine of pregnancy: 600 mcg
- While breastfeeding: 500 mcg
Folic acid benefits in pregnancy
Without enough folic acid in your body, your baby’s neural tube may not close correctly and they could develop health problems called neural tube defects.
Spina bifida: incomplete development of the spinal cord or the vertebrae
Anencephaly: incomplete development of major parts of the brain
Babies with anencephaly usually do not live long, and those with spina bifida may be permanently disabled. These are scary problems, to say the least. But the good news is that getting enough folic acid may protect your baby from neural tube defects by at least 50%. According to the CDC, if you’ve already had a baby with a neural tube defect, getting enough folic acid may reduce your risk of having another child with a neural tube defect by as much as 70%. If you have had a previous child with a neural tube defect, it is recommended that you increase your daily amount of folic acid to 4000 mcg (same as 4 mg) each day.
When taken before and during pregnancy, folic acid may also protect your baby against:
- Cleft lip and palate
- Premature birth
- Low birth weight
- Poor growth in the womb
Folic acid in pregnancy
Pregnant women in particular need a good supply of folic acid because it is used by the developing baby. It has been shown that taking folic acid supplements decreases the chance of spina bifida and other neural tube defects in the baby. The very early stages of pregnancy are crucial in the need for folic acid and this is why folic acid supplements are recommended for women planning a pregnancy.
Extra folic acid is advised for at least the first 12 weeks of pregnancy for all women – even if you are healthy and have a good diet. For most women, a supplement of 400 micrograms of folic acid a day from before conception until the twelfth week of pregnancy is recommended. It is best to start taking the extra folic acid before becoming pregnant. If the pregnancy is unplanned then start taking folic acid as soon as you know you are pregnant. You can buy tablets of folic acid at most health food shops or pharmacies.
If you have had a previous pregnancy affected by a neural tube defect or if there is a family history of such, a supplement of 5 mg (milligrams) of folic acid each day until the twelfth week is recommended. A supplement of 5 mg daily in pregnancy is also recommended for some medical conditions such as coeliac disease, diabetes, and sickle cell anemia, and if you are taking medicines to treat epilepsy. This strength of folic acid tablet is not available to buy. Your doctor will prescribe the tablets for you.
Folic acid in other conditions
Folic acid is also used alongside methotrexate treatment in people with severe Crohn’s disease, psoriasis, and arthritis. When it is used in these medical conditions, folic acid is taken on a different day of the week to methotrexate. It is taken to reduce the side effects which can be caused by methotrexate.
How to take folic acid
- If you have bought folic acid tablets because you are planning to have a baby, read the manufacturer’s printed information on the pack (or from inside it) before you start taking the tablets. Make sure you are clear about what dose to take – the recommended dose is 400 micrograms once daily. The 5 mg tablet has more than ten times as much folic acid as this. If you have any questions, ask a pharmacist to advise you.
- If you have been prescribed 5 mg folic acid tablets by a doctor, take them exactly as you are told to. Depending upon the reason for which you are taking folic acid, you may be asked to take one tablet every day, or one tablet only on certain days of the week. Try to take your doses at the same time of day each day that you take them, as this will help you to remember to take the tablets regularly. There will be more information about folic acid on the manufacturer’s printed information leaflet from inside your pack.
- It is not important whether you take folic acid before or after meals.
- If you forget to take a tablet, take it as soon as you remember. If you do not remember until the following day, skip the forgotten dose. Do not take two doses at the same time to make up for a missed dose.
Getting the most from your treatment
In addition to taking folic acid, try also to eat a healthy diet including foods rich in folic acids, such as spinach, sprouts, broccoli, green beans, and potatoes. Lightly cook the vegetables, as the cooking process reduces the amount of folic acid they contain. Some bread and breakfast cereals are fortified with folic acid also.
Can folic acid cause problems?
Folic acid supplements are unlikely to cause any side effects. The 5 mg tablets may, on rare occasions, cause a mild upset stomach (loss of appetite, nausea, and a bloated feeling). If you experience any symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for advice.
How long after taking folic acid will I get pregnant?
A study found that women taking folic acid were more likely to become pregnant within 12 months. Folic acid had a particular benefit for women with irregular cycles. This was particularly true for women with short, long, or irregular cycles.
Folic acid in pregnancy when to stop taking it
Once you reach 12 weeks pregnant your baby’s spine will have developed, so you can stop taking folic acid if you wish. However, you can continue to take supplements after 12 weeks if you choose to and it won’t harm your baby to do so.
Good food sources of folic acid
Foods that can help you get more folic acid in your diet include:
- 400 mcg: Breakfast cereals fortified with 100% of the DV, 3/4 cup
- 215 mcg: Beef liver, cooked, braised, 3 oz
- 179 mcg: Lentils, mature seeds, cooked, boiled, 1/2 cup
- 115 mcg: Spinach, frozen, cooked, boiled, 1/2 cup
- 110 mcg: Egg noodles, enriched, cooked, 1/2 cup
- 100 mcg: Breakfast cereals, fortified with 25% of the DV, 3/4 cup
- 90 mcg: Great Northern beans, boiled, 1/2 cup
Too much folic acid during pregnancy
Folic acid is important, but taking too much could be problematic. Research is pointing to some possible negative effects of consuming too much folic acid, such as impaired fetal growth, increased risks of childhood diseases like asthma and autism, and promoting the growth of some cancer cells.
It’s important to note that studies showing the cause and effect of too much folic acid have been carried out in animals. Those involving humans have only been observational, meaning other factors could play a role in these links. (Doing controlled, or clinical, studies, where women are given more folic acid to see the effects, would be unethical.)
As concerns about excess folic acid were growing, a workshop on the issue, which included stakeholders from academia, industry, government, and health professional groups was held in Ottawa in November 2017. The workshop conclusions were published in the American Journal of Clinical Nutrition in December 2018.
While it’s unclear exactly how too much folic acid may be harmful, it may involve epigenetics, or the turning on and off of different genes in the fetus, which may play a role in the development of disease later in life.
Some women who are at a higher risk of having a baby with neural tube defects are advised to take higher dosages under the care of their physician, but for most women, there isn’t a benefit to taking more than the recommended dose of folic acid. “If there is no benefit of higher intakes, then there is likely the only risk,” says Deborah O’Connor, a professor in the department of nutritional sciences at the University of Toronto and a co-author of the published paper.