Congratulations on your pregnancy, and your journey to motherhood! While it’s an exciting time, remember, now that you’re expecting, many of the things you do not only affect your health, but the health of your baby, too. One of the best (and easiest) things you can do to give your little one a healthy start is take folic acid throughout your pregnancy.
Below is some information on what folic acid is, what it does, and how it benefits you and your baby:
What Is Folic Acid and Why Is It Important?
Folic acid is a form of the water-soluble vitamin B9. Humans do not store folic acid. We have to consume it every day to ensure we have sufficient amounts. Folic acid is vital to the human body for a variety of reasons, such as:
- Combating heart disease
- Allowing your cells to function properly
- Helping to form your red blood cells and DNA
- Staving off anemia (a deficiency of red blood cells or of hemoglobin in the blood that causes fatigue and weakness)
- Enhancing brain health (including fighting memory loss in old age)
- Preventing serious birth defects in pregnancy
What Happens If You Have Folic Acid (or Folate) Deficiency?
According to the National Institutes of Health, folate or folic acid deficiency is rare, largely because most of us get enough of the nutrient through the foods we eat. Those who suffer from a deficiency usually have other health issues that prevent their bodies from absorbing vitamins (e.g., alcoholism or other nutritional deficiencies). With that said, signs of folate deficiency include:
- Loss of appetite and/or weight loss
- Soreness or ulcers on the tongue
- Changes in hair or skin color
- Elevated homocysteine levels (an amino acid and breakdown product of protein metabolism. When elevated, homocysteine has been linked to a higher risk of heart attack and stroke.)
- Having a child who has a birth defect
In addition to anemia and birth defects, folic acid deficiency could lead to:
- An elevated risk of second heart attacks
- A higher risk of strokes; adding folic acid to foods may contribute to reducing stroke death by decreasing homocysteine levels
- An increased risk of certain cancers, such as stomach cancer
- Possible memory and mental agility issues
- A higher risk of developing clinical depression
- An increased risk of male infertility; folic acid could improve sperm health
Why Is Folic Acid So Critical to a Healthy Pregnancy?
Folic acid is essential to making the extra blood a woman needs during her pregnancy. A deficiency in folic acid during pregnancy can lead to a neural tube defect (problems with brain and spinal cord development). Specifically, lack of folic acid can cause two neural tube defects:
Spina bifida: A condition in which the spinal cord is exposed. If the bones of the spinal column (called vertebrae) that surround the spinal cord do not close correctly during the first 28 days of a pregnancy, the cord or spinal fluid could bulge through, typically in the lower back.
Anencephaly: severe underdevelopment of the brain.
Infants with anencephaly usually do not live long. Those who have spina bifida may have permanent disabilities. As frightening as these conditions sound, ensuring you get enough folic acid in pregnancy can help protect your baby from neural tube defects by at least 50 percent. The Centers for Disease Control and Prevention (CDC) has also noted that mothers who have had a child with a neural tube defect can reduce their risk of having another child with similar defects by as much as 70 percent if they consume enough folic acid before and during pregnancy.
Folic acid can also safeguard babies from:
- Poor growth in the womb
- Premature birth
- Low birth weight
- Cleft lip and palate
Along with benefiting babies, this vitamin superhero may also lower a mother’s risk of pregnancy-related complications, such as preeclampsia (a condition in pregnancy characterized by high blood pressure).
When Should You Begin Taking Folic Acid?
Women of childbearing age (even if not considering getting pregnant) should take a multivitamin that contains folic acid. In the U.S., almost half of all pregnancies are unplanned. Neural tube defects happen in the first month of pregnancy, before a woman may even know she’s pregnant. Taking folic acid before and during early pregnancy is particularly vital to a baby’s health.
Every year, about 3,000 pregnancies are affected by neural tube defects. According to March of Dimes, if all women took 400 micrograms (mcg) of folic acid every day before getting pregnant, as well as during early pregnancy, it could prevent up to 70 percent of neural tube defects.
How Much Folic Acid Should You Take Before and During Pregnancy?
All women of childbearing age should take 400 mcg of folic acid every day. Often, a daily multivitamin will contain at least that amount, but be sure to check the label. If you’d prefer to avoid taking a multivitamin, you can still take folic acid or folate supplements. Here is a quick breakdown of what’s recommended each day during pregnancy:
- While trying to conceive: 400 mcg
- For the first trimester (three months) of your pregnancy: 400 mcg
- During months four to nine: 600 mcg
- While breastfeeding: 500 mcg
When selecting a prenatal (or multivitamin), take it to your obstetrician, midwife or healthcare provider to be sure it has the recommended dose of folic acid, as well as the other nutrients essential for you and your growing baby. Keep in mind: all prenatal vitamins aren’t the same. Some may have less or more of the vitamins and minerals you need.
Will Multivitamins or Prenatal Vitamins Give You Enough Folic Acid?
In the majority of cases, yes. Most multivitamins and prenatal vitamins contain at least 400 mcg of folic acid. Because folic acid’s advantages in pregnancy are well established, supplementation before and especially in the early weeks of pregnancy is very important.
Some women may need more folic acid than what’s typically recommended. Talk to your doctor about how much folic acid you should take, particularly if:
- You’ve had a previous pregnancy affected by a neural tube defect.
- You have diabetes.
- You are obese or significantly overweight (a body-mass index/BMI of 30 or higher).
- You have a hemoglobin disorder, such as sickle cell disease.
- You take anti-seizure medication.
What Is the Difference Between Folate and Folic Acid? Which Should You Take?
Folic acid and folate are often used interchangeably, but the truth is, these two substances are different. Folate (also known as B9) is found naturally in foods. Folic acid is the synthetic form of folate, found in supplements (e.g., mutlivitamins) and also added to many “fortified” or processed foods.
Because neural tube defects happen early on in a pregnancy, public health strategies in the U.S. and beyond have led to mandating folic acid supplementation in foods. For example, in both the U.S. and Canada, folic acid has been added to white flour since the late 1990s.
Most people who generally eat a healthy diet do not need to take folic acid supplements to help meet their folate requirement. With that said, because pregnant women (or women of childbearing age) need to make sure they get enough folic acid into their bodies, experts recommend taking a multivitamin or prenatal vitamin that contains this critical nutrient. For the rest of us, we simply need to eat the right foods.
Check out Chris Kesser’s site for a deeper dive on the difference between folate and folic acid.
What Are Some Good Food Sources That Contain Folate or Folic Acid?
- Beans (e.g., lentils, lima beans, chickpeas)
- Green vegetables (asparagus, broccoli, okra, spinach)
- Citrus fruits, such as orange juice
- Enriched or fortified foods like pasta, white rice, cereals, whole-wheat bread
Looking for tastier ways to get more folate in your diet? Try these recipe ideas from The Radiant Life Blog.
Are There Any Risks Associated With Taking Too Much Folic Acid?
Overall, folic acid has few side effects. Sometimes, supplemental folic acid can hide symptoms of pernicious anemia, a potentially fatal condition caused by a deficiency in B12. Very high doses of folic acid (above 15,000 mcg) can cause stomach problems, sleep issues, skin reactions and seizures. While rare, taking extremely high doses of folic acid could raise your risk of developing colon or rectal cancer.
While side effects usually aren’t noticed, some may experience the following while taking folic acid:
- Sleep problems
- Poor appetite
- Gas or bloating
- Funny taste in mouth
- Feeling depressed or overly excited
Is There Anything Else to Know About Folic Acid?
In supplement form, the absorption of folic acid is decreased (slightly) when taken with food. Taking certain drugs can also deplete folic acid. Some of these medications include:
- Methotrexate (e.g., Trexall, Rheumatrex)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
- Diuretics or water pills
- Certain ulcer medications
- Exenatide (e.g., Byetta, Bydureon)
When combined with vitamin B12, taking folic acid may boost the risk of masking an underlying vitamin B12 deficiency. (Use caution if taking both of these vitamins together.)