Folic Acid and Pregnancy – Benefits, Foods, Supplement & More

You may have heard of folic acid as one of the passing things mentioned in the term ‘multivitamins’, but never really thought about how important it really is to your body. Folic acid supplements in pregnancy are highly essential, and doctors usually prescribe them to pregnant women. But why do you need folic acid for pregnancy planning? Well, folic acid in pregnancy is a major contributor to PREVENTING neural diseases in unborn babies. Yes, that’s how important and powerful folic acid is for pregnancy. To ensure a healthy mother gives birth to a healthy baby, folic acid should be an important part of their diet.

First, let’s start with the basics. Folic acid isn’t called the pregnancy superhero for nothing!

What Is Folic Acid?

Also known as folate, in easy terms, folic acid is a B vitamin, specifically vitamin B9. Naturally, folic acid is found in the form of folate, which is present in foods like dark leafy vegetables, whole grains, pulses and oranges, to name a few. It is especially beneficial for pregnant women (1).

Folic Acid and Pregnant Women

So why is folic acid so vital to pregnant women? What is so special about this particular vitamin that sets it apart from the rest when it comes to pregnancy? Well, not only is this specific vitamin beneficial for you, but it is also good for your baby. Not only does folic acid support rapid placental cell growth, but it also helps protect the unborn baby in the womb from developing birth defects, which is one of the main reasons it is prescribed to pregnant women. In fact, folic acid is a daily requirement and is even recommended to women who are planning to get pregnant or are of childbearing age (2).

So what does it do in the body? Folic acid and vitamin B12 work to form healthy red blood cells, which are imperative for good health. A lack of folic acid in the body can lead to Folate-deficiency anaemia.

Benefits of Folic Acid While Pregnant

Folic acid is especially recommended during early pregnancy as it is imperative for the development of a healthy foetus, especially when the baby’s spine is developing. Consuming folic acid can significantly reduce the risk of neural tube defects or NTDs, the most common of which are:

• Spina bifida, which is when there is an incomplete closure of the spinal cord and spinal column (3)
• Anencephaly, which is when there is severe underdevelopment in the brain
• Encephalocele, a condition where there is an abnormal opening in the baby’s skull from which the brain tissue protrudes.

Babies with these serious neural tube defects usually do not live long, and those suffering from spina bifida may be disabled permanently. Now, what is important to note here is that all the birth defects mentioned above happen during the first 28 days of the pregnancy, which is crucial, because mostly this is the time when the woman does not even know that she’s pregnant! This is the reason why most women who are of childbearing age should make sure to consume enough folic acid, especially if a pregnancy is being planned.

Apart from these, there are more birth defects that folic acid can protect the baby against:

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

Scientists are not really sure why folic acid has such an impact on the foetus, and that too at such an early stage in the development process, but they do know that folic acid is crucial in the development of DNA, since it plays an important role in cell growth and development as well as tissue formation.

To top it all, folic acid is even beneficial to the mother, reducing her risk of:

• Complications in pregnancy
• Miscarriage
• Heart disease
• Stroke
• Certain types of cancers
• Alzheimer’s disease

Women who are on the heavier side have higher chances of giving birth to a baby with a neural tube defect, and that is the reason why significantly overweight women should take more care (and a higher dose of folic acid) during their pregnancy.

How Much Folic Acid Should You Take Before & During Pregnancy?

Unfortunately, for most women, getting their daily dose of folic acid from only fortified foods is not possible, and that is why a vitamin supplement might be required as well.

Let’s look at the dosage required for a woman before and throughout pregnancy in detail.

1. Folic acid before pregnancy

A dosage of folic acid 400 mcg is the recommended value for women of childbearing age, even before they are pregnant. The March of Dimes recommends that every woman above the age of 19, and especially those who are already planning a pregnancy, consume about 400 micrograms (mcg) or 0.4 milligrams of folic acid as a daily requirement (4).

2. Folic acid dose in pregnancy

Here is a quick overview of the dosages during the different stages of pregnancy. Do bear in mind, though, that any supplements need to be prescribed keeping individual needs in mind, and you must consult your doctor to find out what is right for you.

3. During the first 3 months: 400 mcg

Doctors recommend pregnant women consume enough folic acid until 12 weeks or the first 3 months of their pregnancy. The recommended dosage for this again is 400 micrograms (mcg) or 0.4 milligrams of folic acid per day, unless prescribed otherwise.

4. From months 4 to 9: 600 mcg

. This is when a higher dosage of Folic acid is prescribed as the baby begins to develop inside the mother’s womb. Anything between 400- 800 mcg of folic acid is recommended, depending on the individual’s needs.

5. While breastfeeding: 500 mcg (Folic acid 5 mg)

Folic acid is generally considered safe to consume while breastfeeding as well. It is actively secreted into breast milk from the mother to the child. No adverse effects have been noticed in breastfed infants of women consuming folic acid.

You can also choose to continue taking your prenatal vitamins while breastfeeding after discussing it with your doctor, or you can consume a vitamin supplement specially designed for breastfeeding mothers.

In Which Case Do You Require a Higher Dosage?

Women who have an increased risk of having a pregnancy affected by a neural tube defect are advised to take a higher dose of folic acid, especially till the 12th week of pregnancy. These include-

• Women who have a family history of such defects in either their family or their partner’s family.
• Women who have a neural tube defect, or have a partner suffering from it.
• Women who have had a previous pregnancy that was affected by it.
• Pregnant women suffering from diabetes.

Significantly overweight women might also be asked to consume a higher dose of folic acid, as their chances of delivering a baby with a neural tube defect are higher. These women may be advised to consume more than 400 mcg of Folic acid a day.

If a woman is carrying twins, her healthcare provider may recommend as much as 1,000 mcg of folic acid per day (up to 800 mcg of folic acid).

Consuming more than 1000 mcg (folic acid 1mg) a day is not recommended unless advised by your medical practitioner. In fact, this is something women who follow a vegan diet should keep in mind. Vegans are at risk of vitamin B12 deficiency, and consuming too much folic acid can make it harder to diagnose that deficiency.

In a case where a woman has previously been pregnant with a baby suffering from a neural tube defect, she might be asked to take a dose of folic acid as high as 4,000 mcg a day. Women in this situation have a 3 to 5 per cent chance of having another pregnancy with neural tube defect complications.

Women who are consuming anti-epileptic medication might also require a higher dose of folic acid. Smoking and drinking alcohol every day have also been proven to have an impact on the folic acid in the body, so quitting these vices during pregnancy is also recommended.

When Should I Start Taking Folic Acid?

Since birth defects most often happen in the first 3–4 weeks of pregnancy, it is important that you have an adequate amount of folic acid in your system during that crucial time. That is why prenatal vitamins are so important, as they make sure that the body is getting enough good vitamins and minerals to make sure it is baby-ready!

Doctors recommend that you start taking folic acid every day for at least a month before you become pregnant, and every day while you are pregnant (5). You can even start taking it earlier if you are of childbearing age. Folic acid supplementation at least one year before pregnancy can reduce early premature delivery rates by 50 to 70% (6).

Once pregnant, you should continue taking folic acid and iron supplements throughout the pregnancy and for the first six months of breastfeeding.

One thing to note here is that when considering consuming folic acid supplementation in pregnancy, it is best to do so under medical supervision to avoid any unwanted side effects and get the most out of this super-vitamin. Another reason for this is that folic acid supplements in pregnancy might react with some existing medications you’re already on. However, you can continue to eat foods rich in folic acid safely and in moderation.

When you are planning to conceive, make sure to talk to your nutritionist and chalk out an ideal diet plan fortified with enough folic acid to make sure you prep your body well for pregnancy. Folate boosts fertility and development. This should be one of the top things on your priority list while planning to conceive.

Difference Between Folic Acid and Folate

It is common among people to use folic acid and folate interchangeably, as both are forms of vitamin B9. But folic acid and folate are different. Let’s understand how.

Folate is found in whole foods, such as eggs, leafy veggies, and citrus fruits. Folic acid, on the other hand, is the synthesised form commonly used in supplements and processed foods.

A large number of women’s MTHFR genes have a defect that hinders their system from converting synthetic folic acid into active methylfolate. Such women who consume folic acid may not be absorbing their B vitamins as effectively as anticipated. Therefore, in such cases, it is better to obtain folate from whole food sources or supplements that include the natural, active form of folate rather than the synthesised version known as folic acid (7).

Symptoms of Folic Acid Deficiency

The signs of folic acid deficiency can be subtle and might not even be evident. In case of being mildly deficient, you may not notice any symptoms at all, but it means you won’t be getting the optimal amount for your baby’s early embryonic development.

Some of the common symptoms of folic acid deficiency are:

• Weakness
• Fatigue
• Mood swings and behavioural changes
• Irritability
• Diarrhoea
• Loss of appetite
• Headaches
• Sore tongue
• Unexplained weight loss
• Heart palpitations
• Forgetfulness

Bear in mind that many of these symptoms are nonspecific and could indicate other medical conditions as well. Another thing that needs to be noted here is that the symptoms of folate deficiency are very similar to those of an iron deficiency. If you notice any of the symptoms listed above, it is advisable to see a doctor for an accurate diagnosis before you pick over-the-counter supplements. A proper medical investigation helps differentiate between the two and find the correct root causes, so they can be rectified.

Treatment for Folic Acid Deficiency

Treating folic acid deficiency usually involves taking folic acid pills in the dosage recommended by your doctor. In addition, you can benefit by adding foods rich in folic acid to your diet. These include dark green leafy vegetables, cereals, fortified bread, and citrus fruits. Making them a regular part of your diet will help ensure that the deficiency does not recur.

Folic Acid Rich Foods for Pregnancy

While of course there are supplements available for folic acid, it’s also a good idea to eat B12 and folic acid foods. No supplement can simply replace a healthy diet, so during pregnancy, you should make sure that you have a good mix of the two. This will ensure that you’re getting the recommended amount of this pregnancy superhero in your system!

Here are some folic-acid-rich foods that are beneficial for both pregnant women and women trying to conceive.

One thing to note about folic acid is that overcooking folate foods might destroy the nutrient, as it is sensitive to heat. The foods and vegetables rich in folate should be cooked lightly, steamed or consumed raw, preferably unless it is unavoidable, like in the case of rice.

1. Nuts and dried fruits

• Almonds
• Cashew nuts
• Peanuts
• Walnuts
• Sesame seeds

2. Legumes

• Soya bean
• Black-eyed beans
• Kidney beans
• Dried peas
• Chickpeas

3. Grains

• Cooked white rice
• Whole grain flour
• Semolina
• Oats
• Fortified flours

4. Meats

• Egg white
• Liver is also very rich in Folic acid, but it is not recommended to consume when pregnant or trying to become pregnant, as it is also very rich in vitamin A, an excess of which can cause birth defects in the baby.

List of Folic Acid Fruits and Vegetables

Dark green leafy vegetables have quite a reputation for being rich in Folic acid, but there are a lot more fruits and veggies which boast of the same quality, if not the same quantity of folic acid!

1. Vegetables

These consist mostly of dark leafy veggies, which are generally considered rich in folate.

• Spinach
• Kale
• Fenugreek leaves
• Radish leaves
• Green peas
• Corn
• Cauliflower
• Turnip greens
• Beetroot
• Mustard greens
• Ladyfingers
• Broccoli
• Asparagus

2. Fruits

You’ll be surprised to know that a lot of your favourite fruits contain Folic acid in good quantities too!

• Orange
• Strawberries
• Cantaloupe
• Melons
• Banana
• Pineapple
• Raspberries
• Ripe Papaya
• Pomegranate
• Guava
• Avocado

Side Effects of Folic Acid While Pregnant

While consuming folic acid in its natural form (i.e., from food) is generally considered safe, it can be unsafe when consumed as supplements at doses higher than the prescribed amount. Taking 300-400 mcg of folic acid during pregnancy is generally considered a safe quantity. Here are some symptoms one might notice when taking folic acid at higher doses.

• Abdominal cramps
• Diarrhoea
• Rashes on the skin
• Sleep disorders
• Irritability
• Confusion
• Nausea
• Upset stomach
• Skin reactions
• Seizures
• Gas

There are recent medical reports which hint at a link between too much folic acid and autism in children. Lately, moms have been concerned about consuming folic acid during pregnancy due to claims that it is linked to autism. However, anything in excess can be harmful, right? Besides, there is no concrete confirmation that folic acid leads to autism. Also, since folic acid is water-soluble, in most cases, your body does not store the excess. Instead, it gets passed through your urine.

FAQs

1. What foods contain folic acid?

Nuts, beans, peas, pasta, rice, leafy vegetables, citrus fruits, and enriched cereals and bread are known food sources of folic acid.

2. How would I know that my unborn baby is at risk of neural defects, and how can I prevent this?

If your previous pregnancy involved a neural defect, you may be at the greatest risk of a neural defect in the subsequent pregnancy. Not eating a balanced diet that includes folic acid increases the risk. The best way to prevent neural defects in the unborn baby is by taking doctor-recommended 0.6 – 0.8 milligrams of folic acid daily for one month before conceiving and continuing during the first three months of pregnancy (7).

3. What are the risks of not taking folic acid during pregnancy?

Not taking folic acid before and during pregnancy can increase the possibility of neural birth defects in the unborn baby, including spina bifida and anencephaly, which is the severe underdevelopment of the brain.

4. What are the signs of folic acid deficiency in pregnant women?

Pale-looking face, weakness, getting tired quickly, shortness of breath, frequent headaches, swollen tongue, nausea, and vomiting are some signs that can be observed in pregnant women deficient in folic acid.

It is safe to say that folic acid is indeed a pregnancy superhero! In fact, it is great for all women of child-bearing age.. It’s something that’s beneficial for both the mother and the baby, and that should be enough motivation for you to realise the importance of this vitamin before, during and after the course of your pregnancy!

Also Read:

Folic Acid for Fertility
Vitamin B5 during Pregnancy
High Uric Acid in Pregnancy

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Sources References

1. Nemours KidsHealth – Folic Acid and Pregnancy

2. Tommy’s – Folic acid in pregnancy

3. Johns Hopkins Medicine – Folic Acid for a Healthy Baby

4. March of Dimes – Folic acid

5. Pregnancy Birth and Baby – Folate and pregnancy

6. Science Daily – Huge Drop In Preterm Birth-risk Among Women Taking Folic Acid One Year Before Conception

7. American Pregnancy Association – Folic Acid in Pregnancy