Taking a folic acid supplement is one of the most important things a woman can do during the early stages of her pregnancy because it can help prevent birth defects.

A member of the B-vitamin family, folic acid is strongly linked to the prevention of neural tube defects (NTDs), such as spina bifida, and also may prevent heart defects and cleft lip and palate defects. “Folic acid supplementation reduces the incidence of NTDs by 50 to 70 percent,” said Amy Rosenbaum, DO, OB/Gyn at Sunrise Children’s Hospital.

The March of Dimes reports that NTDs affect about 3,000 pregnancies in the United States annually, so if all women took folic acid before getting pregnant and during pregnancy, it could help prevent close to 2,100 of these birth defects.

What is folic acid?

Folic acid is the synthetic form of folate, a type of B-vitamin also sometimes referred to as B9.

“Folic acid is involved in many metabolic processes, including DNA/amino acid synthesis and the formation of red blood cells,” Rosenbaum said. Folic acid also can help repair DNA and RNA, aids in rapid cell division and growth, and is sometimes used to help treat certain types of anemia because of its ability to produce red blood cells.

For pregnant women, folic acid plays a crucial role in the healthy development of the neural tube, brain and spinal cord of the fetus.

When should mothers begin taking folic acid?

“Ideally, a woman should be taking folic acid about a month prior to conception and at least through the first trimester of pregnancy,” Rosenbaum said.

According to the Centers for Disease Control and Prevention, half of all pregnancies in the U.S. are unplanned, and as such, it is recommended that all women between ages 15 and 45 take 400 MCGs of folic acid daily. Most birth defects occur within the first month of pregnancy, before most women even know they’re pregnant, so it’s important for any woman of childbearing age to take folic acid.

While it’s ideal that any pregnant women take folic acid before conception and in the earliest stages of pregnancy, don’t panic if you become pregnant and have not been following these guidelines. “A detailed ultrasound will be completed to look for any abnormalities in the fetus, but the likelihood is that the fetus will still be normal,” Rosenbaum said.

How much folic acid do pregnant women need?

The general recommended dose for a normal, low-risk pregnancy is 400 micrograms (MCGs) a day for pregnant women. However, some women may want or need to take more. It’s a water-soluble vitamin, so there’s usually no harm in taking extra.

“Most prenatal vitamins have 800 micrograms of folic acid and there are certain conditions that require higher doses of folic acid, between four and five milligrams daily,” Rosenbaum said.

Reasons why some women may need to take higher doses of folic acid include:

  • If either parent has a medical history of neural tube defects
  • If the mother already has a child with a neural tube defect
  • If the mother is on certain medications, such as anticonvulsants
  • If the mother has diabetes
  • If the mother has impaired gastrointestinal absorption, such as with Celiac disease

Can you get enough folate from your diet, or do you have to take a folic acid supplement?

Folate (the naturally occurring form of folic acid) is found in dark leafy greens, citrus fruits and beans. Further, many bread and cereal products that are labeled “fortified” or “enriched” contain folic acid.

While the average, healthy person eating a balanced diet is probably getting enough folate from food, women who are, or may become, pregnant need to take a folic acid supplement.

“It would be difficult to quantify how much folate is being consumed due to the way that food is processed and cooked. Also, the bioavailability of the folic acid supplement is higher and therefore more biologically active than folate. For this reason, folic acid is recommended in all pregnancies, regardless of diet,” Rosenbaum said.

Do you need to take a prenatal vitamin?

Prenatal vitamins are recommended for nearly all pregnant women, and they all contain folic acid. However, some women may be sensitive to some of the other vitamins included and may choose not to take the full prenatal vitamin complex.

“Folic acid is the most important component of the prenatal vitamin, and it’s not absolutely necessary to consume other vitamin supplements during pregnancy, though it’s recommended. If the prenatal vitamin isn’t tolerable to a pregnant woman, she can take the folic acid supplement alone. A balanced diet is also encouraged,” Rosenbaum said.

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