Folate requirement in pregnancy

Folic Acid | CDC

CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).

About folic acid

Folic acid is a B vitamin. Our bodies use it to make new cells. Think about the skin, hair, and nails. These–and other parts of the body – make new cells each day. Folic acid is the synthetic (that is, not generally occurring naturally) form of folate used in supplements and in fortified foods such as rice, pasta, bread, and some breakfast cereals

Why folic acid is important before and during pregnancy

When the baby is developing early during pregnancy, folic acid helps form the neural tube. Folic acid is very important because it can help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida). The neural tube forms the early brain and spine.

Women of reproductive age need 400 mcg of folic acid every day

• All women of reproductive age should get 400 mcg of folic acid every day to get enough folic acid to help prevent some birth defects because
  • About half of U.S. pregnancies are unplanned, and
  • Major birth defects of the baby’s brain or spine occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant.

• When taking folic acid, a higher dose than 400 mcg of folic acid each day is not necessarily better to prevent neural tube defects, unless a doctor recommends taking more due to other health conditions.
  • When planning to become pregnant, women who have already had a pregnancy affected by a neural tube defect should consult with their healthcare provider. CDC recommends that these women consume 4,000 mcg of folic acid each day one month before becoming pregnant and through the first 3 months of pregnancy.

Learn more about CDC’s folic acid recommendations here.
Learn more about the recommended intake level of folic acid here.

When to start taking folic acid

Every woman of reproductive age needs to get folic acid every day, whether she is planning to get pregnant or not, to help make new cells.

Are folate and folic acid the same thing?

The terms “folate” and “folic acid” are often used interchangeably, even though they are different. Folate is a general term to describe many different types of vitamin B9.

Types of folate can include

• Dihydrofolate (DHF)
• Tetrahydrofolate (THF)
• 5, 10-methylenetetrahydrofolate (5, 10-Methylene-THF)
• 5-methyltetrahydrofolate (5-Methyl-THF or 5-MTHF)

Food fortification is a way to add vitamins or minerals, or both, to foods. Some rice, pasta, bread, and breakfast cereals are fortified with folic acid. These foods are labeled “enriched.” Folic acid is a specific type of folate that does not generally occur naturally.

Folic acid is the ideal form of folate to use for food fortification. It is more stable than types of natural food folate, which can easily be broken down by heat and light. Folic acid is better suited for food fortification because many fortified products, such as bread and pasta, are cooked.⁶

CDC recommends that women of reproductive age who could become pregnant consume at least 400 micrograms (mcg) of folic acid every day. However, it’s difficult to get 400 mcg of folic acid through diet alone. You can get 400 mcg of folic acid each day by taking a vitamin with folic acid in it, eating fortified foods, or a combination of the two, in addition to consuming a balanced diet rich in natural food folate.

How to get enough folic acid to prevent neural tube defects

In addition to eating foods with folate from a varied diet, women can get folic acid from

• Taking a vitamin that has folic acid in it:
  • Most vitamins sold in the United States have the recommended daily amount of folic acid (400 mcg) that women need for the prevention of neural tube defects. Vitamins can be found at most local pharmacy, grocery, or discount stores.
• Eating fortified foods:
  • You can find folic acid in some breads, breakfast cereals, and corn masa flour.
• Getting a combination of the two: taking a vitamin that has folic acid in it and eating fortified foods.

If taking folic acid for reasons other than neural tube defect prevention, talk to your healthcare provider.

Learn more about where to find folic acid in the United States here.

More Information

For more information, visit the Frequently Asked Questions page.

You can also contact CDC-INFO in English or Spanish:

• 1-800-CDC-INFO (800-232-4636)
• TTY: 1-888-232-6348
• In English
• en español

Folic acid

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KEY POINTS

• Taking folic acid before and during early pregnancy can help prevent neural tube defects in your baby.  

• Before pregnancy, take a vitamin supplement that has 400 micrograms of folic acid in it every day.

• During pregnancy, take a prenatal vitamin that has 600 micrograms of folic acid in it every day.

• Take a vitamin supplement with folic acid every day, even if you’re not trying to get pregnant.

• You can get folic acid from food, too. Look for fortified foods to make sure you’re getting enough.

What is folic acid?

Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy, it can help protect your baby from birth defects of the brain and spine called neural tube defects. The neural tube is the part of a developing baby that becomes the brain and spinal cord. NTDs happen in the first month of pregnancy, before you may know that you’re pregnant. This is why it’s important to have enough folic acid in your body before you get pregnant.

NTDs affect about 3,000 pregnancies each year in the United States. If all women take 400 micrograms (also called mcg) of folic acid every day before getting pregnant and during early pregnancy, it may help prevent up to 7 in 10 (70 percent) NTDs. Because nearly half of all pregnancies in the United States are unplanned, all women who can get pregnant should take folic acid every day.

Some studies show that folic acid also may help prevent  birth defects in a baby’s mouth called cleft lip and palate. A cleft lip is a birth defect in which a baby’s upper lip doesn’t form completely and has an opening in it.

How can you get enough folic acid?

There are several ways to get enough folic acid:

• Taking a vitamin that has folic acid in it
• Eating foods with folate from a varied diet
• Eating fortified foods
• Getting a combination of the two: taking a vitamin that has folic acid in it and eating fortified foods

Here’s what you need to know about taking folic acid to prevent NTDs:

Most women
To help prevent NTDs in your baby, take a vitamin supplement with 400 mcg of folic acid every day before you get pregnant. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in the foods you eat. Start taking 400 mcg of folic acid each day at least 1 month before pregnancy through the first 12 weeks of pregnancy. Your folic acid supplement can be:

• A multivitamin. This is a pill that contains many vitamins and other nutrients that help your body stay healthy.
• A prenatal vitamin. This is a multivitamin made for pregnant women. Your health care provider may give you a prescription for prenatal vitamins, or you can get them over the counter without a prescription. 
• A supplement that contains just folic acid

Take a vitamin supplement with 400 mcg of folic acid each day, even if you’re not trying to get pregnant.

During pregnancy, take a prenatal vitamin each day that has 600 mcg of folic acid in it. Folic acid only works to prevent NTDs before and during the first few weeks of pregnancy. Later in pregnancy, you need 600 mcg of folic acid each day to help your baby grow and develop.

Women at high risk for NTDs
If you’re at high risk for having a baby with an NTD, take 4,000 mcg of folic acid each day to help prevent an NTD. Start taking 4,000 mcg of folic acid 3 months before you get pregnant through 12 weeks of pregnancy. You’re at high risk if:

• You’ve had a baby with an NTD in the past.
• You or your partner has an NTD.
• Your partner has a child with an NTD.

Studies show that taking 4,000 mcg of folic acid before and during early pregnancy can help reduce your risk of having another baby with an NTD by about 70 percent. Ask your provider how to safely get this much folic acid. It’s not safe to take several multivitamins or prenatal vitamins because you can get too much of other nutrients, which may be harmful to your health. Your provider can help you figure out the best and safest way for you to get the right amount of folic acid.

How can you get folic acid from food?

You can get folic acid from food. Some foods are fortified with folic acid. Fortified means a food has folic acid added to it. Check the product label to see how much folic acid you get in each serving. Look for the word “fortified” or “enriched” on labels on foods like:

• Bread
• Breakfast cereal
• Cornmeal
• Flour
• Pasta
• Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco shells, tamales and pupusas
• White rice

Some fruits and vegetables are good sources of folic acid. When folic acid is found naturally in food it’s called folate. Foods that are good sources of folate are:

• Beans, like lentils, pinto beans and black beans
• Leafy green vegetables, like spinach and Romaine lettuce
• Asparagus 
• Broccoli
• Peanuts (But don’t eat them if you have a peanut allergy.) 
• Citrus fruits, like oranges and grapefruit
• Orange juice (100 percent juice is best. This means one serving of juice is equal to one serving of fruit.) 

It’s hard to get all of the folic acid you need from food. Even if you eat foods that have folic acid in them, take your vitamin supplement each day, too. 

How do you read a product label to see how much folic acid is in a vitamin supplement?

To find out if a vitamin supplement has folic acid in it, check the label (also called supplement facts). The label is usually on the back of the bottle. Look for the word “folate” on the label to see how much folic acid you’re getting. The label tells you this information:

• Serving size. This tells you how much of the product is in one serving. One multivitamin usually is one serving. 
• Servings per container. This tells you how many servings are in a multivitamin bottle. For example, if two pills are one serving and the bottle has 30 multivitamins in it, that’s 15 servings. 
• Nutrients, like vitamin D, folate and calcium, in each serving
• Daily value (also called DV) of one serving. DV is the amount of a nutrient in a serving. For example, if the DV of folic acid in a multivitamin is 50 percent, that multivitamin gives you 50 percent (half) of the folic acid you need each day. 

Vitamin supplement labels now list “mcg DFE of folate,” which stands for dietary folate equivalent. It’s the amount of folate your body absorbs. If a serving has less than 400 mcg DFE of folate, you need more than one serving to get all the folic acid you need each day. 

Labels on food products don’t always list the amount of folic acid in the product. Newer food labels that list folic acid will list mcg DFE of folate, just like for vitamin supplements.

If you have an MTHFR variant, can taking folic acid help prevent NTDs in your baby?

Yes. If you have an MTHFR variant, taking 400 mcg of folic acid every day before and during early pregnancy can help prevent NTDS in your baby.

MTHFR stands for methylenetetrahydrofolate reductase. It’s an enzyme (protein) that helps your body break down and use folate. One MTHFR variant (called MTHFRTT or CT genotype) is a change in your body’s MTHFR gene that makes you use folate more slowly than usual. Genes are parts of your body’s cells that store instructions for how your body grows and works. They are inherited (passed from parents to children). MTHFR variants are inherited. If you know you have an MTHFR variant or you think it runs in your family, talk to your provider.

Your provider may want to test you for an MTHFR variant if you have high levels of a substance in your blood called homocysteine. Too much homocysteine in your blood can cause heart conditions, blood clots and stroke. You can find out your homocysteine levels with a blood test. If your level is high, you can have a genetic test  to see if you have an MTHFR variant. A genetic test looks for changes in genes that can cause birth defects or other medical conditions.

You may have heard not to take folic acid if you have an MTHFR variant because it can increase your risk of pregnancy complications and your baby having health problems. The Centers for Disease Control and Prevention (also called CDC) recommends that all women take 400 mcg of folic acid every day before and during early pregnancy. If you have an MTHFR variant, talk to your provider.

Additional versions of this article are available in: Arabic, Chinese Simplified, Hindi, and Urdu
Translated documents are courtesy of the employees of CooperSurgical Inc.

Folic Acid Health Action Sheet

More information

• Centers for Disease Control and Prevention (CDC)
• Show Your Love Preconception Health

Last reviewed: May 2020

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Pregnancy and nutrients: when, what and how much?

Summary. It's no secret that during pregnancy a woman's body should receive a sufficient amount of vitamins, micro and macro elements necessary for the normal course of pregnancy and fetal development. Is it possible to fill the deficiency of vitamins with the help of food? What micronutrients should a pregnant woman take? What is the optimal dose of folic acid during pregnancy? These questions were answered during the training workshop for gynecologists "Actual GuideLines of Gynecology, Reproductology, Obstetrics", which took place on 29March 2019 in Kharkov, answered Tamara Romanenko , Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology No. 1 of the National Medical Academy of Postgraduate Education named after P.L. Shupyk. The event was organized by the MedExpert Group of Companies, National Medical University named after A.A. Bogomolets and the National Medical Academy of Postgraduate Education named after P.L. Shupyk.

Micronutrients and women's reproductive health

Micronutrients (vitamins, macro- and microelements) are sources of energy, participate in the assimilation of food, regulate functions that carry out the processes of growth, adaptation and development of the whole organism. It has been proven that the amount of vitamins and minerals in women of reproductive age is significantly reduced. Most often, they are deficient in folate, iron, vitamins D, A and B ₆ zinc.

In modern conditions, when a person is not engaged in physical labor, his need for energy and nutrients is lower, but this does not apply to vitamins and minerals. The high intensity of metabolic processes in modern people is associated with the pressure of an aggressive environment, intellectual stress, stress, and various situations in family life. At the same time, the need for vitamins and minerals increases to the greatest extent during periods when a woman is preparing to become a mother, pregnancy and breastfeeding. To ensure the required amount of vitamins, a woman should consume a large number of quality foods. At the same time, it should be remembered that the amount of vitamins in food decreases during heat treatment, long-term and improper storage, canning, and intensive processing of food. The degree of digestibility of vitamins with food can vary between 5–80%.

The speaker emphasized that a diet composed exclusively of natural products cannot fully meet a person's need for essential micronutrients. Possible risk factors for vitamin and mineral deficiency can be inadequate nutrition in quantity and quality, somatic diseases, genetically determined anomalies of vitamin metabolism, the influence of environmental factors, the use of certain drugs, overweight or underweight, young or old age, bad habits.

Vitamin deficiencies and pregnancy

Women eat a significant amount of food that is low in vitamins and minerals, their diet is often unbalanced. Violation of the rational nutrition of the mother before and during pregnancy is one of the causes of congenital malformations and other pathologies. It is known that congenital malformations can occur due to various endogenous and exogenous processes and causes (genetic defects, exposure to toxic substances, drugs, ionizing radiation, somatic and extragenital pathology in the expectant mother, etc. ). However, since ancient times, there has been a clear relationship between maternal nutrition and the birth of children with congenital malformations. A poor-quality and quantitatively depleted diet of a future mother poses a threat to the normal development of the child, as well as to the course of the entire process of pregnancy and the health of a woman in the future. Both insufficient and excessive amounts of vitamins can be one of the causes of congenital malformations.

Vitamins and minerals are necessary for the normal development of the child at all stages. So, in the period before conception, it is important for the future mother to receive zinc, folate, iron, vitamins B ₆ , B ₁₂ and D, in the first trimester of pregnancy - folate, iron, vitamins B ₁₂ and D, during II-III trimester - iron, calcium, vitamins, in the postpartum period and during breastfeeding - iron, calcium, vitamin D, fats and proteins.

Pregnancy is associated with changes in metabolism, the work of the hormonal system, the blood system, therefore, during this period, the need for vitamins and minerals increases. So, during pregnancy, the body needs 1.5 times more calcium, zinc and iodine, and the need for individual vitamins and trace elements increases to 50–80%. For example, the need for folic acid increases by 50%, vitamin B ₁₂ - by 11%, iron - by 83%.

Folic acid

During pregnancy, the need for folic acid increases by 150%. Folic acid deficiency during pregnancy increases the risk of preeclampsia, development of placental dysfunction with fetal growth retardation syndrome, miscarriage, miscarriage, premature birth. At the same time, not only the insufficiency of the effect of folate matters, but also the toxic effect of homocysteine, which freely penetrates the placenta and can harm the unborn child.

The role of folates and hyperhomocysteinemia

Recently, special attention has been paid to the study of risk factors for such a severe pregnancy complication as preeclampsia. The results of the studies show a 40% reduction in the risk of developing preeclampsia in pregnant women taking folic acid 1 month before the onset of gestation.

With a lack of folic acid, hyperhomocysteinemia can occur - a pathological condition of the body, manifested by an increased concentration of homocysteine ​​in the blood (normal concentration in blood plasma is 10 μmol / l). The level of homocysteine ​​may increase in vitamin deficiency states (deficiency of folic acid, vitamin B ₆ , B ₁₂ and B ₁ ), increased intake of methionine from food, smoking and coffee abuse, sedentary lifestyle, kidney disease, drug use, concomitant diseases, genetic inheritance (the most studied is a defect in the enzyme methylenetetrahydrofolate reductase MTH - MTH ).

Deficiency of folic acid, vitamins B ₁₂ and B ₆ leads to hyperhomocysteinemia, which causes the development of endothelial dysfunction, thrombus formation, immune maladjustment, oxidative stress, which in turn leads to impaired uteroplacental and fetoplacental blood circulation - the risk of miscarriage, premature birth, preeclampsia, nephropathy of pregnant women, placental abruption, intrauterine fetal death increases.

Folic acid is a methyl group donor, which is necessary for the conversion of homocysteine ​​to methionine. In order for homocysteine ​​to be converted into methionine, a woman from the planning period of pregnancy and the first trimester of pregnancy must receive a sufficient amount of folic acid. It has been shown that the number of cases of premature birth in women who took a sufficient amount of folic acid in combination with vitamins during pregnancy is 2 times lower than in pregnant women who did not take multivitamin preparations.

Folic acid: choosing the optimal dose

What is the optimal dose of folic acid? The data presented by the speaker from a meta-analysis of 25 randomized controlled trials indicate that the more folate, the less homocysteine. 800 mcg of folate has been shown to reduce homocysteine ​​levels by an average of 23%. Increasing the dose of folic acid to non-physiological 2 and 5 mg reduces the level of homocysteine ​​slightly compared with a dose of 800 mcg. Addition of vitamin B 9 to the treatment regimen0011 12 at a dose of 0.4 mg / day, on average, increases the effect by 7%.

906 nmol/l is the concentration of folic acid in erythrocytes at which the risk of congenital malformations, in particular neural tube defects, is the lowest. This is exactly what the concentration of folic acid should be so that the risk of developing defects is minimal. It has been proven that the duration of folic acid intake necessary to achieve its concentration in erythrocytes of 906 nmol/l should be:

• at a dose of 400 mcg / day - 8-12 weeks;
• at a dose of 800 mcg / day - 4.2-3.5 weeks.