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Folic Acid and Pregnancy: Why Do You Need It?

folic acid foodsYou’ve probably heard that you need to take folic acid before and during your pregnancy, but did you ever ask yourself, Why? What is folic acid for in pregnancy? Why do I need to take this supplement?

Folic acid (called folate in its natural form) is a water soluble B-vitamin, and it plays a key role in the production of healthy new cells. All people – men and women – need folic acid in their diet, but this nutrient is very crucial for a woman before and after her pregnancy. Folic acid has been proven to reduce the risk of birth defects that affect the brain and spinal column.

The Benefits of Folic Acid

For women trying to conceive, as well as pregnant women, the major benefit of folic acid is that it can prevent neural tube defects (NTDs) – which are birth defects that affect a fetus’ brain and spinal column. The most common types of NTDs include:

  • Spina Bifida – This is the most common neural tube defect, and it affects over 166,000 people in the United States. Over four million American babies are born with this birth defect annually. Spina bifida occurs early in the first trimester, when the baby’s spinal column doesn’t close all the way. (The bones of the vertebrae don’t form properly around the fetus’ spinal cord.) 
  • Anencephaly – A very serious and fatal birth defect, anencephaly occurs when the upper part of the neural tube doesn’t close all the way. As a result, the baby develops without the forebrain (the front part of the brain) and without the cerebrum (the part of the brain that controls thinking and coordination). In other words, babies with anencephaly are born without parts of the brain and skull. Almost all babies with this birth defect will die shortly after birth. 
  • Encephalocele – A rare neural tube defect, encephalocele occurs when the bones of the skull don’t close completely. As a result, part of the brain can come through the hole in the skull. Only 20 percent of babies with this NTD are born alive, and only half of those babies will survive.

Neural tube defects occur in the first weeks of pregnancy (the first 28 days) – even before the woman realizes she is pregnant. Up to 70 percent of NTDs can be prevented if a mom-to-be starts taking folic acid at least one month before and throughout her pregnancy.

Researchers aren’t completely sure why folic acid plays such a major role in neural tube defects, but they theorize it’s because folic acid plays a crucial role in the development of DNA, tissue formation, and cell growth and development.

In addition to helping prevent neural tube defects, research has found that folic acid may help protect against other birth defects, too. Getting enough folic acid in your diet before and during pregnancy can also help prevent the following problems:

  • Cleft lip and cleft palate – These birth defects occur when part of the lip and/or palate (the roof of the mouth) doesn’t completely fuse together in the first trimester. As a result, the baby with cleft lip is born with a physical split of the two sides of the upper lip, and a baby with a cleft palate has an opening in the roof of his/her mouth. According to one study, women who ate a healthy diet and took regular multivitamins (with at least 400 micrograms of folic acid every day) had the lowest risk of having a baby with a cleft lip.
  • Pregnancy complications – In one research study, women who took regular folic acid supplements during their second trimester had a lower risk of developing preeclampsia – pregnancy-induced hypertension (high blood pressure). Preeclampsia is a serious pregnancy complication that may result in bed rest, preterm labor and delivery, and other problems.
  • Premature birth – Studies have linked folic acid before pregnancy with a lower risk of preterm labor and delivery. In one study, women who took folic acid for at least one year prior to pregnancy decreased their risk of preterm birth by over 50 percent.
  • Miscarriage, poor growth in the womb, and low birth weight – There’s also evidence that taking folic acid before and during pregnancy can lower your chance of miscarriage, a baby who experiences poor growth in the womb, and a baby who is born at a low birth weight (less than 5 pounds, 8 ounces).

For women who are not pregnant, or trying to conceive, folic acid also helps protect you from certain health conditions. Research has linked regular folic acid intake to decrease your risk of certain cancers, heart disease, stroke, and even Alzheimer’s disease.

Folic Acid Before Pregnancy

Now that you’ve heard all the great benefits of folic acid, you should be double-checking your multivitamins and making sure that they include folic acid. If they don’t, you may want to switch to another multivitamin or take a folic acid supplement. If you are planning to conceive, you need to start taking folic acid at least one month before you get pregnant.

All women need at least 400 micrograms (mcg) of folic acid every day. Most multivitamins have this amount, but you should always check the label to double check. You can also get folate from your diet – eating leafy green vegetables, plenty of citrus fruits, whole grains, and beans.

Because 50 percent of all pregnancies are unplanned, you should make it a habit of taking a multivitamin (with at least 400 mcg of folic acid) every day. Remember that neural tube defects occur in the first 28 days of pregnancy – before most women realize that they’re pregnant.

Certain women may need to take more than 400 micrograms (0.4 mg) of folic acid a day. These women include:

  • Those who have a baby with a neural tube defect, or a previous pregnancy affected with NTDs.
  • Obese women
  • Women who are taking medications for epilepsy
  • Women with diabetes, thalassaemia, sickle cell anemia, or celiac disease.

Women who are at high risk for a neural tube defect may need a prescription of 4,000 micrograms of folic acid. If you’re at high risk, talk to your doctor about your folic acid needs prior to conceiving.

For most women, though, they only need 400 micrograms before pregnancy.

Besides preventing neural tube defects, taking folic acid supplements also improves your chances of getting pregnant. When you’re trying to get pregnant, you really don’t have a reason to not to get folic acid into your diet.

According to a 2006 study that involves over 18,000 women, taking folic acid daily decreased a woman’s risk of having problems producing eggs – which is the second largest cause of female fertility. Women who took multivitamins with folic acid had a 40 percent lower risk for ovulatory failure, compared to women who did not take the vitamins.

Folic Acid During Pregnancy

Do not stop taking folic acid when you become pregnant. During pregnancy, women need at least 600 to 800 micrograms of folic acid every day. Talk to your obstetrician, midwife, or healthcare provider about the right amount for you. You need to continue taking folic acid during the entire length of your pregnancy.

Folic acid in pregnancy helps prevent neural tube defects, cleft lip and cleft palette, and it even reduces the risk of miscarriage, preterm birth, and other pregnancy complications. On top of all those benefits, getting enough folic acid when you’re pregnant also helps your baby’s development after birth.

According to a 2011 study from the Norwegian Institute of Public Health, folic acid in pregnancy might help protect with language development after birth. The researchers surveyed nearly 40,000 women and they found that mothers who took folic acid during pregnancy were less likely to have children with severe language delays in toddlerhood.

Other studies have also linked folic acid in pregnancy to decrease a child’s risk for future cancer. Since folic acid is essential in DNA synthesis, it is possible that folic acid may give you some protection against certain cancers.

Folic Acid in Foods

Folate is found naturally in leafy green vegetables, oranges and citrus fruits, beans, and whole grains. Folic acid (which is the synthetic or manmade form of this nutrient) is added to many commercial food products, like breads, flours, pasta, breakfast cereals, and more.

You can find folic acid in the following foods:

  • Leafy green vegetables – like spinach, broccoli, and romaine lettuce
  • Asparagus
  • Peanuts and Nuts
  • Enriched breads and pasta
  • Oranges and Orange Juice
  • Bananas
  • Fortified Breakfast Cereals (Double check the label to see how much folic acid is in the cereal you’re eating.)
  • Green Peas
  • Cornmeal
  • White rice
  • Avocado
  • Wheat germ
  • Tomato Juice
  • Turnip Greens
  • Eggs
  • Cantaloupe
  • Papaya

If you’re eating a breakfast cereal, bread or pasta product, you can check the label on the package to see how much folic acid it contains. Find the word “folate” (or “folic acid”) on the label to see the daily value.

Don’t worry about overdosing with folic acid. It is not toxic, since it is a water soluble B-vitamin. Whatever folic acid isn’t used by your body will be removed through your urine.

Keep in mind that eating folate foods isn’t enough to reach the daily recommended level of folic acid. If you are trying to conceive, you need to start taking a vitamin supplement with at least 400 micrograms of folic acid.


About the author: DP Nguyen is founder and editor of Hip Chick’s Guide to PMS, Pregnancy and Babies. She’s an expert pregnancy and women’s health blogger. She is NOT a medical doctor and does NOT offer medical advice. Connect with her on Google+, Twitter and Facebook.

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