Folic Acid: The Vitamin You Need for a Healthy Pregnancy

A picture of vegetables to symbolize where you can get enough folic acid during pregnancy.

Folic acid is vital to a healthy pregnancy and a healthy newborn. Adequate levels of folic acid help ensure full-term delivery, healthy birth weight, and complete brain and nervous system development.    

Over the course of your 40 weeks of pregnancy, folic acid supports baby’s development, lowering their risk of health issues like low birth weight and birth defects.  It’s also vital for a healthy placenta, reducing the potential for pregnancy complications such as preeclampsia, preterm births, and miscarriages11

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What is Folic Acid?

Folic acid and folate are both forms of B9, an essential vitamin for a healthy nervous system and proper brain functioning.  Folic acid (folate) plays an important role in cell division/replication, DNA and RNA synthesis2, and red blood cell production.  

Why is Folic Acid Important During Pregnancy?

While everyone needs folic acid (folate), it’s especially important during pregnancy, when your placenta and baby are rapidly developing, and your blood supply is increasing with the growing demands of pregnancy.  As an antioxidant, it’s critically important for accurate DNA replication by neutralizing free radicals1.  

Folic acid supports the earliest stages of development. 

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When planning to conceive, it’s important to be prepared in advance with enough folic acid to support the earliest stages of development, when embryonic and placental cells are rapidly dividing.  Certain birth defects of the brain and spine occur within the first 28 days after conception, before many women even know they’re pregnant, so starting early with a folic acid regimen improves baby’s chances for healthy brain and spinal cord development. 

Taking folic acid before and during pregnancy can greatly reduce the risks of neural tube birth defects (NTDs), one of the most common forms of birth defects2.  The Centers for Disease Control and Prevention (CDC) report that taking the recommended daily dose of folic acid at least one month before conception through the first trimester, can reduce baby's risk of neural tube defects by up to 70%.  

Folic acid also appears to lower rates of placenta-related pregnancy complications, and helps prevent congenital heart disease.  It may also help with depression that sometimes happens after baby is born.

Indirect evidence3also suggests that folate (folic acid) may be important in the timing of labor, helping reduce or prevent pre-term birth, a major cause of neonatal mortality; short-term respiratory, gastrointestinal, immunological, and central nervous system complications; and long-term motor, cognitive and neurobehavioral issues.

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How Much Folic Acid Should I Take During Pregnancy?

Doctors and researchers recommend women consume folic acid daily, starting one to three months before conception and continuing during breast-feeding. They further recommend that daily folic acid consumption prior to conception is particularly important for women with a personal or family history of NTD, or a prior child with a NTD.

Women may require more or less folic acid than the daily-recommended dose, depending on individual circumstances, and daily recommended doses might vary depending on the source, so it’s important you consult with your doctor before starting a pregnancy regimen.

Doctors and researchers recommend women consume folic acid daily. 

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How Do I Get Enough Folic Acid?

A healthy, nutritious diet will go a long way towards ensuring you have sufficient levels of folate (folic acid) in your pregnancy dietFolate is found naturally in foods such as dark leafy greens, such as collard or turnip greens; vegetables such as avocado, broccoli, okra, beets, and asparagus; legumes, such as beans and lentils; citrus fruit; and liver, to name a few.

While many foods have additional folate to prevent deficiency, it’s likely your doctor will recommend folic acid supplements. Folic acid was developed as a dietary supplement to ensure your body gets enough folate.  It’s available in prenatal vitamins and fortified or enriched foods such as cold cereals, bread, pasta, cookies, and crackers.

What are the Signs that I Have a Folate Deficiency?

Symptoms of a folate deficiency are often subtle, and include fatigue, grey hair, mouth sores, and tongue swelling.  Lack of adequate folic acid (folate) can also cause anemia, a deficiency in red blood cells (RBCs) that causes persistent fatigue, weakness, lethargy, shortness of breath, and irritability. 

A folate deficiency also increases the risk for elevated blood homocysteine, which has been linked with spontaneous abortions and pregnancy complications (e.g., placental abruption and preeclampsia)4

How Does Baby Get Enough Folic Acid?

Your placenta plays a vital role in transporting folic acid to baby.  Folates concentrate within your placenta and are then transferred to baby.  Because folate is vitally important to baby’s development, this “transport mechanism” starts early in the first trimester.  With high concentrations being transferred across your placenta, fetal levels of folic acid can be two to four times higher than maternal levels5.  Another reason to be sure you get enough for your body’s needs in addition to baby’s.

Folic Acid and Autism?

While folic acid is vital for baby’s health, it’s important not to overdo it.  Excess folic acid during pregnancy may be linked to autism spectrum disorder.  A study conducted at the Johns Hopkins Bloomberg School of Public Health6 in Baltimore suggests that excessive amounts of folate (vitamin B9) and vitamin B12 in a mother’s body might increase a baby’s risk of developing an autism spectrum disorder.

In the study, mothers who had very high blood levels of folate at delivery were twice as likely to have a child with autism compared to mothers with normal folate levels.  In addition, mothers with excessive B12 levels were three times as likely to have a child with autism. The risk was greatest among mothers who had an excess level of both folate and B12 – over 17 times higher than mothers with normal levels of both. However, researchers noted that the study only found an association, but could not prove that high levels caused an increased risk of autism.

What’s the Bottom Line?

The benefits of folic acid on healthy cells are undeniable, and studies have shown its benefits on the prevention of neural tube defects to be significant.  Although not confirmed, concerns over excess folic acid should be taken into consideration.  Folic acid appears to be safe and should be part of prenatal nutrition. In all cases, you should talk with your doctor about how much folic acid is right for you, what sources of folic acid best suit your lifestyle, and when you should begin taking folic acid supplements. 

Learn more about how to maintain a healthy pregnancy diet