Folic acid

What is folic acid?

Folic acid (also known as folate) is a B-vitamin found in many foods, including dark green leafy vegetables, fruits, nuts, beans, peas, dairy products, meat, eggs, and grains. It is required for the production of new cells and for proper synthesis of DNA. This vitamin is particularly important to a baby’s health and development. To be effective, folic acid must be taken before conception. It is not helpful to start after the pregnancy is established.

Why is folic acid so important in pregnancy?

Folic acid helps prevent some types of birth defects called ‘neural tube defects’. These happen when the fetal spinal column doesn’t close completely or the brain and skull don’t develop properly. Other defects including cleft palate and some heart defects may also be related to inadequate folic acid intake.

How much folic acid should I be taking?

It is not only the amount of folic acid that you take that is important, but the timing. Most neural tube defects happen in the first 4 weeks of pregnancy, often before the mother is even aware she is pregnant. Roughly half of pregnancies are unplanned, so even if you are not trying to get pregnant but are of reproductive age, consider taking a daily multivitamin containing 0.4 mg folic acid. If you are trying to conceive, folic acid supplementation differs depending on your particular risk for neural tube defects. In addition to eating a diet rich in folic acid, follow the recommendations in this table.

RISK LEVEL	DEFINITION OF RISK LEVEL	FOLIC ACID DOSE	WHEN TO TAKE IT
LOW	You and your male partner have no personal or family history of birth defects known to be related to folic acid	0.4 mg per day	2-3 months before conception Throughout pregnancy For 4-6 weeks after delivery or as long as breastfeeding continues
MODERATE	You or your male partner have family history of birth defects known to be related to folic acid You have type I or II diabetes You are taking medications known to impact folic acid metabolism (e.g., anti-seizure medications, metformin, methotrexate) You have a condition that reduces folic acid absorption (e.g., Crohn’s, Celiac disease)	1.0 mg per day 0.4-1.0 mg per day	At least 3 months before conception until 12 weeks gestation; THEN: From 12 weeks gestation until 4-6 weeks after delivery or as long as breastfeeding continues
HIGH	You or your male partner have a neural-tube defect You have had a previous neural tube defect pregnancy	4.0 mg per day* 0.4-1.0 mg per day	At least 3 months before conception and until 12 weeks gestations; THEN: From 12 weeks gestation until 4-6 weeks after delivery or as long as

*A multivitamin containing 1 mg folic acid, plus 3 single 1 mg folic acid tablets