It’s Folic Acid Awareness Week and January also marks Birth Defects Awareness Month. As leaders in maternal-fetal and obstetric care, Pediatrix® Medical Group is committed to helping women have healthy pregnancies—and healthy babies.
We sat down with Suzanne Bovone, M.D., an obstetrician-gynecologist with Obstetrix & Gynecology of San Jose, to discuss how folate and folic acid play an important role in prenatal care.
What are folate and folic acid?
Folate, also known as vitamin B-9, helps the body form red blood cells and aids cell growth and function. Folic acid is the synthetic form of folate.
Why are folate and folic acid important for women trying to conceive?
As a baby develops in the womb, the neural tube grows to form the brain and nervous system. The tube closes during the first weeks of pregnancy, often before a woman knows that she’s pregnant. If the neural tube doesn’t close properly, birth defects like spina bifida (a spinal cord defect) and anencephaly (a brain defect) can occur.
If a woman consumes folic acid before and during early pregnancy, it can help decrease the risk of neural tube defects. In fact, after the U.S. Food & Drug Administration began requiring food producers to enrich certain products with folic acid in 1998, neural tube defects declined by 35%.
However, a woman’s first prenatal visit may not happen until as late as the 12th week of pregnancy, when starting folic acid is too late to prevent defects. That’s why raising awareness of the benefits of folate and folic acid pre-conception is so important.
When should women who are trying to conceive start incorporating folic acid into their diets?
Because an estimated 45% of pregnancies are unplanned, I recommend that all sexually active women of reproductive age try to get some folate and/or folic acid daily. However, it’s very difficult for most women to get the daily recommended amount of folate through food alone, so taking folic acid supplements can help bridge the gap.
If you are trying to conceive, you should begin folic acid at least one month before trying to get pregnant. However, in most cases, we recommend that women start three months before trying to conceive to ensure they get into the habit of getting enough folic acid before conception.
In what foods can you find folic acid and folate?
Folic acid can be found in prenatal vitamins, multivitamins and other supplements, as well as in fortified foods, such as bread, pasta, rice and many breakfast cereals.
Folate can be found in spinach, liver, asparagus, Brussel sprouts, citrus fruit, apple juice, orange juice, chickpeas, lima beans, kidney beans, eggs and nuts. Because we as clinicians believe that food is a form of medicine, we recommend that women of childbearing age try to get folate naturally as part of a well-balanced diet. But it’s important to note that cooking foods that are naturally rich in folate can degrade the strength of the vitamin, so try to eat these foods raw, steamed or only lightly cooked.
Visit the March of Dimes for more information.
How much folic acid do I need?
For women with an average risk of having a baby with birth defects, taking 400 micrograms of folic acid before getting pregnant can help prevent neural tube defects. This can come from either diet and/or prenatal vitamins or multivitamins. Be sure to read the vitamin label to ensure it contains enough folic acid.
During pregnancy, women should take a prenatal vitamin with 400 micrograms of folic acid each day, according to the Centers for Disease Control and Prevention (CDC). While folic acid only works to prevent neural tube defects before and during the first few weeks of pregnancy, you need 400 micrograms daily of folic acid to help your baby grow and develop properly during pregnancy.
If you have a higher risk of having a baby with a neural tube defect, you should take 4,000 micrograms (4 milligrams) of folic acid daily. You are considered high risk if you or your partner have a neural tube defect or if either of you has a baby with a neural tube defect. Taking 4,000 micrograms of folic acid before and during early pregnancy can help reduce your risk of having another baby with a neural tube defect by about 70%. If you are high risk, start taking the recommended dose three months before you get pregnant through the first 12 weeks of pregnancy.
You also may need to take a higher amount of folic acid if you smoke, are severely overweight, take medications that can interfere with your metabolism or have certain medical conditions, including malabsorption syndrome, diabetes or seizure disorders.
Is it possible to get too much folic acid?
No. Because folic acid is water-soluble, if you ingest more than your body can use, you will excrete it in your urine. However, folic acid is often paired with vitamins A and D in prenatal vitamins, and it is possible to get too much of those vitamins. Ask your provider how to get enough folic acid safely.
Pre-conception counseling is an important step in your journey to have a baby. Contact your health care provider to give you and your baby the best chance for a healthy pregnancy.