When you’re pregnant, it becomes more important than ever to eat healthy, stay fit, and give your body the supply of nutrients it needs. Folic acid or vitamin B9, in particular, figures prominently in pregnancy-related nutrition. After all, it plays a vital role in the healthy development of cells, the spine, and brain of your baby. Yet, about 90 percent of women consume less than the recommended daily levels of folate for pregnancy and only a minority (the other 10 percent) meet the requirement. If you’re in this 90 percent, your pregnancy, planned or otherwise, could put you on the backfoot and expose your baby to the risk of serious neural tube defects.
Neural tube defects are defects that affect a child’s brain and spinal cord development. Ones that tend to affect most pregnancies are3:
Spina bifida: A condition where the spinal column and spinal cord are not closed completely. It results in mobility problems, learning disabilities, social issues, and a host of other health problems for the child.
Anencephaly: Severe brain development problem that causes parts of the brain and skull to be completely absent, resulting in stillbirth or survival for only a few hours after birth
Encephalocele: In this birth defect, a portion of the baby’s brain tissue and membranes protrude in a sac via an abnormal opening in the skull.
Researchers have found that consuming at least 0.4 mg of folic acid every day before you conceive and in early pregnancy can cut the risk of serious neural tube defects in the baby by as much as 70 percent.4 Strong a reason as any to start monitoring folic acid intake right away!
Getting your 0.4 mg of folic acid daily may cut the risk of your baby developing a cleft lip by as much as a third! In one Norwegian study, researchers estimated that about 22 percent of isolated cleft palate cases could have been avoided if women ensured they took their daily recommended levels of folic acid. The country doesn’t permit folic acid fortification of foods and also has the highest incidence of facial clefts in Europe.5
You should take folic acid for your own good health as well. Women of childbearing age are more prone to developing folate deficiency anemia than men.6 Folate is needed by your body for the formation of and normal growth of red blood cells. When you don’t take adequate levels of the vitamin, your red blood cells can become abnormally large. Pregnancy itself can raise your risk for this problem, leaving you more fatigued, with a sore mouth and tongue, headaches, and general pallor. Ensuring recommended intake of this B vitamin can spare you the discomfort and risk of this form of anemia.7
When you should start taking folic acid will depend on a couple of factors, including:
whether or not you’re trying to get pregnant at the moment
whether you are already pregnant
In fact, health authorities like the US Public Health Service suggest that women between 15 and 45 years of age take folic acid every day anyway since about half of the pregnancies in the United States are unplanned.8 If you’re caught off guard and have an accidental pregnancy, you would not want a deficiency of folic acid to cause birth defects in your baby.
Even if this isn’t something you want to do otherwise, gear up to meet your folate requirements if you’re of childbearing age and are contemplating a family. Start having folate even before you go off contraception, certainly once you start trying to conceive, and through your first trimester.9 Most neural tube birth defects – the kind that folic acid could prevent – occur in the first 28 days of your pregnancy, often before you even realize you are expecting.10
Intake must be kept up till you’re in the 12th week of pregnancy as this is the stage where the baby develops a spine. If you’ve forgotten to take folic acid or weren’t aware that you should and are already pregnant, start taking the recommended amount every day from now on.11
In the United States, both the US Public Health Service and the Centers for Disease Control and Prevention recommend the daily intake of 0.4 mg or 400 mcg (micrograms) of folic acid in normal healthy women of childbearing age, especially those who are trying to get pregnant or are already pregnant.12 Across the pond, the Department of Health in the United Kingdom also suggests similar intake in women trying to conceive.13
If you have a higher risk of having an infant with a neural tube defect due to your own medical or prior pregnancy history, you will need higher doses of folic acid in the lead up to and during the pregnancy. Typically, this might mean higher doses of folic acid (as much as 5 mg) every day all the way up to the 12th week of your pregnancy. Those most at risk for such complications are14:
Where either partner has a neural tube defect themselves
Where there is a family history of such defects (on either the mother or father-to-be’s side)
If prior pregnancies have been affected by neural tube defects
Certain medications, including anti-epileptic medicines, certain antibiotics, and non-steroidal anti-inflammatory drugs, can prevent your body’s cells from using the folic acid you consume. These folic acid antagonists may raise the risk of neural tube defects as well as of urinary tract defects, cardiovascular defects, and oral clefts. Do consult your doctor to see if you need to take higher amounts of folic acid directly or via multivitamins.15 This may especially apply to you if you are on medication for16:
Type 2 diabetes
If you also want a more healthy and natural way to consume folic acid, consider increasing dietary intake of the nutrient. There are plenty of good food sources of folic acid during pregnancy, so take your pick. Here are some readily available foods that are rich in folates, the naturally occurring form of folic acid17:
Dark green leafy vegetables, spinach
Poultry like turkey, chicken
Beans, peas, chickpeas
Get a more detailed list here.
Besides these, certain foods may contain added folic acid. Check labeling for the quantity of the vitamin and try to consume fortified breakfast cereals, pasta, breads, cornmeal, flours and even white rice that have added folic acid.19
Important as it is, consuming very high dosages of folic acid via supplements or fortified foods can cause a few problem for you. If you take in over 1 mg a day, for instance, you might mask a genuine vitamin B12 deficiency. If that goes unchecked, you even run the risk of nervous system damage, so it is important to spot and diagnose it early.20
There are also concerns over a possible connection between very high intake of folic acid before and during pregnancy and the chance of having a child with autism. Research on this front is very much in its early stages and nothing conclusive can be said as yet.21 Another piece of research on use of folic acid supplements during pregnancy has found that there could be a slightly higher risk of the baby developing lower respiratory tract infections and wheezing if you choose this route instead of a natural dietary source.22 That said, your body’s need for folic acid is non-negotiable during pregnancy. And for women who need the additional folic acid due to health conditions they have, supplements may be inevitable. It is best to discuss your concerns with your doctor to choose what’s right for you.
While getting in plenty of natural sources of folic acid is a good idea during pregnancy, health experts like the National Health Service point out that it may be almost impossible to get all the required amount of folic acid from food sources alone during this time. Some amount of supplementation is needed.23
There isn’t a concern about having too many natural foods rich in folic acid even if you’re pregnant – they don’t have any major side effects nor do they conflict with supplements you take. But if you have a large amount of fortified foods or multivitamins and other supplements, you need to closely monitor your folic acid levels. Keep tabs on the quantity in each serving size of fortified food or capsule or supplement. Stick to the recommended 0.4 mg unless your doctor has specifically told you otherwise.24 Your end goal is to get the right amount of folic acid, not too little or too much.