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. Because there may not be enough folic acid in the diet, it is recommended that all women who are trying to get pregnant, or who might become pregnant, take supplemental folic acid. To be useful, the folic acid must be taken for at least three months before conception. It is not helpful to start it after the diagnosis of a pregnancy.

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. Some examples of neural tube defects are spina bifida and anencephaly. Other defects including cleft palate, 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. For most women, a daily dose of 0.4 mg of folic acid per day throughout pregnancy and until breastfeeding ends is enough. If you have risk factors for neural tube defects or have had a previous pregnancy with a neural tube defect, you may need to take more. 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

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