Why you need folic acid during pregnancy

Women who are pregnant or might become pregnant need folic acid (vitamin B9 or folate, as it's known in its naturally occurring state) for a number of compelling reasons:

• Folic acid helps prevent neural tube defects (NTDs) – serious birth defects of the spinal cord (such as spina bifida) and the brain (anencephaly). Neural tube defects occur at a very early stage of development, before many women even know they're pregnant. They affect about 3,000 pregnancies a year in the United States.

Pregnancy Calendar
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 they conceive and during the first trimester of pregnancy reduce their baby's risk of neural tube defects by 50 to 70 percent.

• Some research suggests that folic acid may help lower your baby's risk of other defects as well, such as cleft lip, cleft palate, and certain types of heart defects.
• Your body needs folate to make normal red blood cells and prevent anemia.
• Folate is essential for the production, repair, and functioning of DNA, our genetic map and a basic building block of cells. So getting enough folic acid is particularly important for the rapid cell growth of the placenta and your developing baby.
• Some research suggests that taking a multivitamin with folic acid may reduce your risk of preeclampsia, a complex disorder that can affect your health and your baby's.

How much folic acid you need :

To reduce your baby's risk of having a neural tube defect, experts recommend taking 400 micrograms (mcg) of folic acid per day, beginning at least a month before you start trying to get pregnant.
In fact, because 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 other experts strongly recommend that all women of childbearing age get 400 mcg of folic acid every day. Some groups, such as the U.S. National Institutes of Health, suggest boosting your intake to at least 600 mcg daily once you're pregnant.
The neural tube – from which your baby's spine and brain will develop – begins to form about three weeks after conception, so it's critical to get a sufficient daily dose of folic acid before conception and during the first trimester of pregnancy.
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. (Never double up on your multivitamins.)
If you're taking prescription prenatal vitamins, they probably contain 800 to 1,000 mcg of folic acid. Again, check the label.
Don't take more than 1,000 mcg per day of folic acid unless your healthcare provider advises you to. In the unlikely event that you have a vitamin B12 deficiency, too much folic acid can mask a condition called pernicious anemia.

When you might need extra folic acid :

Women who are obese appear to be more likely to have a baby with a neural tube defect, although the reason for this is still unclear. If you're significantly overweight, see your healthcare provider before you try to conceive. Among other things, she may advise you to take somewhat more than 400 mcg of folic acid.
If you've previously been pregnant with a baby affected by a neural tube defect, be sure your current providers are aware of this, and schedule a visit before trying to get pregnant. With no intervention, women in this situation have a 2 to 5 percent chance of having another pregnancy complicated by an NTD.
The good news is that this risk can be reduced significantly by taking a very large dose (4 milligrams [mg], which is equal to 4,000 micrograms) of folic acid beginning one month before conception and continuing through the first three months of pregnancy.
To enable you to get 4 milligrams of folic acid, your provider would prescribe a prenatal vitamin with 1 mg of folic acid, plus three 1 mg folic acid tablets to start taking one month before you try to get pregnant, continuing through the first trimester.
Women who are diabetic or are taking certain anti-seizure medications are also more likely to have a pregnancy affected by an NTD. If either of these situations applies to you, see your provider at least a month before trying to conceive to find out how much folic acid you should be taking and to monitor your condition in general.

Food sources of folic acid :

Oddly enough, research shows that the body actually absorbs the synthetic version of this vitamin much better than the version that occurs naturally in certain foods. While enriched cereals and other grain products are fortified with the synthetic version, most women don't eat enough of these foods to get enough folic acid this way either.
A number of foods are rich in naturally occurring folate, including lentils; dried beans and peas; dark green vegetables such as broccoli, spinach, collard or turnip greens, okra, and asparagus; and citrus fruit and juice. These healthy foods have other nutrients as well and should be part of a balanced diet.
These foods aren't a substitute for supplemental folic acid, though. Instead, consider them a complement to your supplement. Because while your body absorbs all of the folic acid in a supplement, it absorbs only some of the naturally occurring folate from the food you eat. What's more, folate can be lost during storage or destroyed by cooking.
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 so that each serving contains at least 20 percent of the daily requirement, and some breakfast cereals contain 100 percent.
That said, unless you go out of your way to eat a complete serving of a fully fortified cereal – that is, one that contains 100 percent of the Daily Value of folic acid – every day, you probably won't get enough synthetic folic acid from food.

Should you take a supplement?

Definitely. If you're like most people, you don't get the amount of folate you need from your diet. Many authorities, including ACOG and the March of Dimes, recommend that all women of childbearing age take a multivitamin with folic acid or a folic acid supplement every single day.

The signs of a folic acid deficiency :

The signs of folic acid deficiency can be subtle. You may have diarrhea, 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 at all, but you won't be getting the optimal amount for your baby's early embryonic development.