folic acid pregnancy

Folic Acid In Pregnancy, Importance, Dosage, When to Start ?

What is folic acid?

Folic acid, or folate, is a B vitamin. The word folate comes from folium, the Latin word for leaf. Folate occurs naturally in food, particularly in dark, green leafy vegetables, citrus fruits, whole meal bread, yeast, liver, and legumes (peas, beans, lentils, chickpeas, etc.). It is best to consume fresh fruit and vegetables, as cooking and prolonged storage can destroy the folate. Folic acid is the synthetic form of folate used in multivitamins, supplements and fortified foods and drinks. It is easier for your body to absorb and use folic acid than naturally occurring folate in food. Researchers discovered the importance of folate in preventing anemia about 70 years ago. But only in recent years have they learned of the link between folate deficiency and certain birth defects.

Foods containing folic acid

Foods naturally high in folate or fortified with folic acid include:

  • Raw fruit, well-washed or peeled (citrus is especially high in folate).
  • Bread and cereals, especially wholegrain.
  • Well-washed, fresh, raw, or lightly cooked vegetables, especially leafy green vegetables such as spinach, as well as asparagus and corn.
  • Cooked dried beans, peas, and lentils.
  • Yeast extracts, e.g., Marmite and Vegemite.
  • Freshly cooked liver and kidney (no more than 1 serving a week).
  • Folic acid-fortified breakfast cereals, bread, or fruit juice.

Foods fortified with folic acid should state this on their ingredients list and/or nutrition information panel (NIP). The food label will list any vitamins added, such as folic acid. The total amount of folate in the NIP includes the natural folate as well as the amount of folic acid that has been added.

Importance of folic acid

Folic acid can help ensure the healthy development of babies in early pregnancy. The lack of folic acid has been linked to birth defects called neural tube defects, such as spina bifida. Folate deficiency can also lead to a type of anemia called megaloblastic anemia.

Who needs folic acid?

Folate/folic acid is particularly important during pregnancy when cells are growing and dividing very quickly. It is recommended that pregnant women or women who are planning to become pregnant take a folic acid supplement.

Older people and people on certain medications, including anticonvulsants and proton pump inhibitors (PPIs), may be at risk of folate deficiency and may also need to take folic acid supplements.

Benefits of folic acid in pregnancy

Sspina bifida

Early in pregnancy, when the fetus is developing, folic acid plays an important role in the development of the neural tube. As the fetus grows, the neural tube develops into the brain and spinal cord. Sometimes, an abnormality occurs when the neural tube does not close properly. This causes conditions known as neural tube defects (NTDs). Neural tube defects happen in about 1 in 500 babies. Some examples of neural tube defects are spina bifida and anencephaly, where the spine or its covering sticks out of the back, and anencephaly, in which the brain doesn’t form properly. Babies born with these defects often die or have problems with walking and bowel and bladder control. Research shows that women who have a high level of folic acid before they become pregnant are less likely to give birth to a baby with a neural tube defect. Folic acid supplementation can prevent up to 70% of these defects.

Amount of folic acid to take during pregnancy

During your pregnancy, you should eat plenty of foods with folate in them, such as leafy green vegetables, wholegrain breads, and cereals. However, you will not get enough folate from food to prevent NTDs.

The only way to be sure you’re getting the right amount of folic acid during pregnancy is by taking a supplement. 400-800 microgram is the usual does of folic acid for the prevention of NTDs for low risk pregnant ladies who are not anemic or deficient in folic acid. Some dietary supplements and multivitamins have small amounts of folic acid, but it may not be enough for you.

High-risk Pregnancies: Some women are at increased risk of having a baby with a spinal cord problem. These women need higher doses of folic acid, 5 milligrams once a day. You are at higher risk if:

  • You have had a previous pregnancy affected by a neural tube defect
  • You or your partner have a spinal cord defect
  • You or your partner have family members with a spinal cord defect
  • You are taking medication that is known to affect folate metabolism, such as medicine for epilepsy (e.g. carbamazepine, sodium valproate)
  • You are on insulin treatment for diabetes
  • You are very overweight, that is, if your body mass index (BMI) is 30 or more
  • You have coeliac disease, diabetes, sickle cell anemia or thalassemia.

When to start taking folic acid for pregnancy

If you are planning a pregnancy or are pregnant, the advice for most women is to take one 400-800 micrograms (mcg) folic acid tablet daily for at least 4 weeks before getting pregnant and to continue taking the tablet daily until the end of week 12 of your pregnancy. If you find you are pregnant during the first 12 weeks of pregnancy, you should take the tablet from that point until the end of week 12.

If you find out you are pregnant and haven’t been taking a folic acid tablet, start taking tablets straight away.


Dr Sobia Mohyuddin

MCPS, FCPS, MRCOG, Consultant Obstetrics & Gynaecology

Doctor Sobia Mohyuddin is a highly skilled and experienced Obstetrician and Gynecologist, with 25 years of training and experience in renowned, large institutions. She holds the position of Associate Professor and Fellow at the College of Physicians and Surgeons Pakistan. She is also a member of the Royal College of Obstetricians and Gynecologists (UK).