Why You Really Need Folic Acid When You’re Pregnant

If you’re pregnant or might become pregnant, it’s critically important for you to get enough folic acid, the synthetic form of vitamin B9, also known as folate. Folic acid plays an important role in the production of red blood cells and helps prevent neural tube defects (NTDs) which are serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). The neural tube is the part of the embryo where your baby’s spine and brain development begin. NTDs affect approximately 3,000 pregnancies annually in the U.S.

Folic acid helps prevent neural tube defects

Navid Mootabar, MD, FACOG

Neural tube defects occur at a very early stage of development, before many women even know they’re pregnant. This is why it’s so important to begin taking folic acid before you start trying to conceive.

The Centers for Disease Control and Prevention (CDC) reports that women who take the recommended daily dose of folic acid starting at least one month before conception and continuing through their pregnancy reduce their baby’s risk of neural tube defects by up to 70%.

In addition, some research suggests that folic acid may help lower your baby’s risk of other birth defects as well, such as cleft lip, cleft palate, and certain types of heart defects. It may also reduce your risk of preeclampsia, a serious blood pressure disorder that affects approximately 5% of pregnant women.

What exactly does folic acid do for you and your baby?

Your body needs the nutrient folic acid to make normal red blood cells and prevent a certain type of anemia. It’s also essential for the production, repair and functioning of DNA, our genetic map and a basic building block of cells. Getting enough folic acid is particularly important for the rapid cell growth of the placenta and your developing baby. The best food sources of folic acid are fortified cereals, and it is found naturally in dark green vegetables and citrus fruits.

When taken before and during pregnancy, folic acid may also protect your baby against:

  • Cleft lip and palate
  • Premature birth
  • Low birth weight
  • Miscarriage
  • Poor growth in the womb

Folic acid has also been suggested to reduce your risk of:

  • Pregnancy complications, especially preeclampsia.)
  • Heart disease
  • Stroke
  • Some types of cancers
  • Alzheimer’s disease

When you should start taking folic acid

Birth defects occur within the first 3-4 weeks of pregnancy, so it’s important to have folate in your system during those early stages when your baby’s brain and spinal cord are developing. Most healthcare providers and OB/GYNs, including all of us at Westchester Health, recommend that women who are trying to get pregnant should start taking a prenatal vitamin with folic acid. One study showed that women who took folic acid for at least a year before getting pregnant cut their chances of premature delivery by 50% or more.

How much folic acid do you need?

To reduce your baby’s risk of developing a neural tube defect, experts recommend that women of childbearing age take 400 micrograms (mcg) of folic acid a day, beginning at least a month before they start trying to get pregnant. If you take a multivitamin every day, check to see if it has the recommended amount. If it doesn’t, you can take folic acid supplements.

Here’s the recommended daily amount of folic acid you should take before and during your pregnancy:

  • While trying to conceive: 400 mcg
  • For the first 3 months of pregnancy: 400 mcg
  • For months 4-9 of pregnancy: 600 mcg
  • While breastfeeding: 500 mcg

You should take folic acid even if you’re not pregnant

Since half of the pregnancies in the United States are unplanned, the CDC, the U.S. Public Health Service, the March of Dimes, the American College of Obstetricians and Gynecologists (ACOG) and many other experts strongly recommend that all women of childbearing age get 400 mcg of folic acid every day. Check the label of your multivitamin supplement to be sure you’re getting enough. If you’re not, you can switch brands or take folic acid separately.

DO NOT TAKE more than 1,000 mcg of folic acid per day unless your healthcare provider advises you to. This is particularly important if you are a vegan. Vegans are at risk of being deficient in vitamin B12, and taking too much folic acid would make it hard to diagnose that deficiency.

When you might need extra folic acid

1) Women who are obese appear to be more likely to have a baby with a neural tube defect. If you’re significantly overweight, see your healthcare provider before you try to conceive. He/she may advise you to take more than 400 mcg of folic acid a day.

2) If you’ve previously been pregnant with a baby with a neural tube defect, you’ll probably be advised to take 4,000 mcg of folic acid a day. Be sure your healthcare provider is aware of your history. With no intervention, women in this situation have a 3-5% chance of having another pregnancy complicated by a neural tube defect.

3) If you’re carrying twins, your healthcare provider may recommend as much as 1,000 mcg of folic acid per day.

4) Some people have a genetic variation (methylenetetrahydrofolate reductase (MTHFR) mutation) that makes it more difficult to process folate and folic acid. If you know you have this mutation, talk with your doctor to make sure you’re getting enough folic acid.

5) Women who are diabetic or are taking certain anti-seizure medications are also more likely to have a baby with an NTD. If either of these situations applies to you, see your healthcare provider at least a month before trying to conceive to find out how much folic acid you should be taking and for him/her to monitor your condition.

Good food sources of folic acid

Food manufacturers are required by the U.S. Food and Drug Administration to add folic acid to enriched grain products, such as breakfast cereals, bread, pasta and rice. Some fortified breakfast cereals contain 100% of the recommended daily amount.

Other good sources include:

  • Lentils
  • beef liver
  • dried beans, peas and nuts
  • cooked lentils
  • avocado
  • dark green vegetables such as broccoli, spinach, collard or turnip greens, okra, Brussels sprouts and asparagus
  • egg noodles
  • citrus fruit and juice

Signs of a folic acid deficiency

The signs of folic acid deficiency can be subtle. You may have diarrhea, anemia, loss of appetite and weight loss, as well as weakness, a sore tongue, headaches, heart palpitations and irritability. If you’re only mildly deficient, you may not notice any symptoms, but the important thing to remember is that you are not getting the optimal amount for your baby’s early embryonic development. This is why it’s so important to get the recommended daily dose and to regularly see your healthcare provider.

Want to know more about folic acid? Come see us.

If you’d like more information on how much folic acid you should be taking and the part it plays in preventing birth defects, please make an appointment with Westchester Health to see one of our OB/GYNs. He/she will answer all your questions, give you lots of health and pregnancy information, and advise you on your folic acid intake so that you and your growing baby can both be as healthy as possible. Whenever, wherever you need us, we’re here for you.

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By Navid Mootabar M.D. F.A.C.O.G., Chairman Department Obstetrics & Gynecology, Director at Large, Institute of Robotic & Minimally Invasive Surgery, Northern Westchester Hospital, Mount Kisco, NY, Northwell Health SystemWestchester Health, member of Northwell Health Physician Partners

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