Folic acid need for 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.
- 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.
- 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.
- 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 and Pregnancy (for Parents)
Reviewed by: Thinh Phu Nguyen, MD
Fetal Medicine at Nemours Children's Health
en español El ácido fólico y el embarazo
Having a healthy baby means making sure you're healthy too.
One of the most important ways to help prevent serious birth defects in your baby is to get enough folic acid every day — especially before conception and during early pregnancy.
What Is Folic Acid?
Folic acid (or folate) is a B vitamin (B9) found mostly in dark green vegetables like broccoli and spinach, legumes such as beans and peas, and enriched grains.
What Are the Benefits of Folic Acid?
Women who are pregnant or trying to become pregnant should get at least 400 micrograms (0.4 milligrams) of folic acid daily before conception and for at least 3 months afterward. Studies show that this greatly reduces a baby's risk of serious neural tube defects.
What Are Neural Tube Defects?
Neural tube defects are birth defects that involve incomplete development of the brain and spinal cord. The most common neural tube defects are:
- spina bifida: when the spinal cord and spinal column don't completely close
- anencephaly: when the skull, scalp, and brain do not form properly
- encephalocele: when brain tissue protrudes out to the skin through an opening in the skull
These defects happen during the first 28 days of pregnancy — usually before a woman even knows she's pregnant.
That's why it's so important for all women of childbearing age to get enough folic (FOE-lik) acid, not just those who are trying to become pregnant. Half of all pregnancies are not planned, so anyone who could become pregnant should make sure to get enough folic acid.
It's not clear why folic acid has such a profound effect on the prevention of neural tube defects. But experts do know that it's vital to the development of DNA. As a result, folic acid plays a large role in cell growth and development, as well as tissue formation.
How Can I Get Enough Folic Acid?
The U.S. Food and Drug Administration (FDA) requires food-makers to add folic acid to their enriched grain products. So you can boost your intake by eating breakfast cereals, breads, pastas, and rice that have 100% of the recommended daily folic acid allowance. Check the product's label for this information.
But for most women, eating fortified foods isn't enough. To reach the recommended daily level, you'll probably need a vitamin supplement.
During pregnancy, you need more of all essential nutrients than you did before you became pregnant.
Prenatal vitamins shouldn't replace a well-balanced diet. But taking them can give your body — and your baby — an added boost of vitamins and minerals. Some health care providers recommend taking a folic acid supplement in addition to a prenatal vitamin. Talk to your doctor about your daily folic acid intake. They might recommend a prescription supplement, an over-the-counter brand, or both.
Also talk to your doctor if you've already had a pregnancy that was affected by a neural tube defect or if you or your partner were affected by one yourselves. The doctor may recommend that you take a higher dose of folic acid (even before a pregnancy).
Reviewed by: Thinh Phu Nguyen, MD
Date reviewed: July 2022
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.
When planning pregnancy and pregnancy itself, it is not possible to replenish this amount of folic acid with food. It has been proven that European women with a quality diet with food receive 0.3 mg of folic acid per day (should be 0.8 mg). In order to make up the difference of 0.5 mg/day, you need to eat 15 servings of spinach or broccoli (foods with the maximum content of folates or folic acid).
MTHFR enzyme deficiency
The speaker recalled that MTHFR enzyme deficiency leads to poor absorption of folic acid. According to the Ukrainian Institute of Clinical Genetics of Kharkiv National Medical University, a decrease in the activity of the MTHFR enzyme by 65% is observed in homozygotes (7.04% of Ukrainians) and by 30% in heterozygotes (40.7% of Ukrainians). It has been shown that the absorption of different types of folates in the presence of genetic mutations is different. So, when taking 200 μg of folic acid, patients with a heterozygous carrier type will not receive enough folic acid (48% of patients will not receive an adequate dose). In the presence of genetic mutations, the amount of folic acid that can be absorbed from a dose of 400 mcg is significantly reduced (48% of patients will not receive an adequate dose of folic acid). In the presence of genetic mutations, the amount of folic acid that can be absorbed from a dose of 800 mcg is reduced only in patients with homozygous mutations, this is only 7% of the total.
It has been proven that 800 mcg of folic acid provides the body with folates even in the presence of a heterozygous defect in the MTHFR enzyme.
Vitamin D (cholecalciferol)
Vitamin D is also important during pregnancy, the need for it increases in the II-III trimester of pregnancy. Vitamin D has a positive effect on the development of the fetus and the course of pregnancy itself. At the same time, a lack of cholecalciferol is associated with an increased risk of intrauterine infections and gestosis and can lead to a delay in the development of the fetal skeleton, a decrease in body weight at birth, and a risk of rickets in children.
According to the Order of the Ministry of Health (MoH) of Ukraine dated July 15, 2011 No. 417 "On the organization of outpatient obstetric and gynecological care in Ukraine", during pregnancy and lactation, the recommended dose of vitamin D is 10 mcg or 400 IU / day .
The Royal College of Obstetricians & Gynecologists recommend that women at risk of preeclampsia take 800 IU of vitamin D daily as a preventive measure.
Iron
It has been proven that during pregnancy it is advisable to use ferrous rather than ferric iron preparations, which have fewer side effects. Ferrous iron is absorbed more efficiently, transported faster, and the level of ferritin and hemoglobin increases on the 2nd or 3rd day.
In accordance with Ukrainian recommendations (Order of the Ministry of Health of Ukraine dated 15.07.2011 No. 417), every woman who comes to register for pregnancy must undergo screening for latent anemia. The National Institute for Health and Care Excellence recommends that pregnant women should be screened for anemia and supplemented with iron if indicated.
The combination of iron and folic acid supplements reduces the risk of neonatal and infant mortality. A decrease in neonatal and infant mortality by 35% and 33%, respectively, was shown among live births whose mothers started taking iron and folic acid supplements in the first 4 months of gestation.
It should be remembered that iron deficiency anemia is a factor in aggravating the course of pregnancy and the risk of developing major obstetric syndromes, in particular, in the mother it can increase the risk of preeclampsia, mortality, in the fetus - fetal growth retardation syndrome, early development of placental dysfunction, in children born on against the background of anemia during pregnancy, metabolic syndrome, schizophrenia, mental retardation.
Multivitamin complexes: international recommendations
In accordance with the Canadian principles of preconception prevention of birth defects at low risk, a multivitamin containing 0.4-1.0 mg of folic acid should be taken 2-3 months before conception, throughout pregnancy and 6 weeks after delivery (lactation period) ). At moderate risk, daily multivitamin preparations with 1.0 mg of folic acid are recommended for at least 3 months before conception, for 12 weeks of gestation, then 0.4–1.0 mg of folic acid from the 12th week until the end of pregnancy and 6 weeks postpartum. At high risk, take a multivitamin with 1.0 mg of folic acid and an additional 3.0 mg of folic acid (for a total of 4.0 mg) or a prescription multivitamin containing 5.0 mg of folic acid at least 3 months before conception and 12 weeks of gestation.
The United States Prevention Task Force (USPSTF) recommends a vitamin supplement containing 400–800 mcg of folic acid for women planning pregnancy.
The Italian recommendations for nutrient use during pregnancy and lactation indicate that vitamin complexes should ideally be given 2 months before pregnancy at a dose of 800 mcg.
New Zealand OB/GYNs recommend taking 800 micrograms of folic acid daily for at least 4 weeks before pregnancy and for 12 weeks after pregnancy to reduce the risk of developing neural tube defects.
The experience of the USA and European countries shows that vitamin-mineral complexes are the best choice for women. To ensure a sufficient amount of micronutrients during the periods of preparation for pregnancy, pregnancy itself and breastfeeding, it is advisable to use vitamin-mineral complexes with proven effectiveness. When choosing a multivitamin-mineral complex, preference should be given to preparations containing the full range of essential vitamins and trace elements that provide the daily requirement of a pregnant woman. European and American experts do not recommend the use of dietary supplements during pregnancy, only drugs with proven efficacy and safety.
It has been shown that the intake of a vitamin-mineral complex containing 12 vitamins and 7 minerals, by 9Reduces the risk of neural tube defects by 2%, heart defects by 58%, urinary system defects by 79%, limb defects by 81%.
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Marina Kolesnik,
photo of the author
Arpimed
What is Folic Acid and what is it used for
Folic acid is a B vitamin. Folic acid can be used:
to treat:
- folic acid deficiency anemia due to malnutrition, malabsorption of nutrients (for example, celiac disease or indigestion), with an increased body need for this vitamin (for example, during pregnancy).
prophylaxis:
- folic acid deficiency caused by certain drugs (such as those used to treat epilepsy, such as phenytoin, phenobarbital, and primidone).
- folic acid deficiency caused by prolonged destruction of red blood cells (hemolytic anemia) or kidney dialysis.
- development of neural tube defects of the fetus (for example, spina bifida) in women with an increased risk of its development in the fetus.
What you need to know before taking Folic Acid
Do not take Folic Acid and tell your doctor if you have: Talk to your doctor or pharmacist before taking Folic Acid if: Other medicines and Folic acid Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. In particular: Pregnancy and breast-feeding If you are pregnant, planning to become pregnant or breast-feeding ask your doctor or pharmacist for advice before taking any medicines. Sugar intolerance If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine because it contains lactose. How to take Folic Acid Always take Folic Acid exactly as prescribed by your doctor. If you have any doubts, you should consult your doctor or pharmacist. Swallow the tablets with water. Dosage Adults (including the elderly): Children: For young children, it is recommended to use a more convenient dosage form of the drug. Children 12-18 years: 5 mg - 10 mg once a day (5 - 10 tablets of 1 mg). Children 12-18 years: 5-10 mg (5-10 1 mg tablets) daily. If you have taken more Folic Acid than recommended If you (or someone else) has taken too many pills at the same time, or if you think your child has accidentally swallowed a pill, contact emergency services immediately nearest hospital or tell your doctor. If you forget to take Folic Acid If you forget to take your next dose, take it as soon as you remember, then take the next dose at the usual recommended time. Do not take a double dose to make up for a missed dose. Possible side effects Like all medicines, folic acid can cause side effects, although not everyone gets them. Call your healthcare provider if you experience any of the following side effects, if they get worse, or if any of the following side effects are not listed in this package insert: Rare (may affect more than 1 in 10,000 but less than 1 in 1,000 people): Reporting side effects: Tell your doctor, pharmacist or nurse if you notice any side effects. This includes any possible side effects not listed in this package insert. You can also report side effects to Arpimed LLC by going to the website www.arpimed.com and filling out the appropriate form “Report a side effect or ineffectiveness of a drug” and to the Scientific Center for Expertise of Drugs and Medical Technologies named after. Academician E.Gabrielyan by going to the website www.pharm.am in the section "Report a side effect of a drug" and fill out the form "Map of reporting a side effect of a drug". Scientific center hotline: +37410200505; +37496220505 How to store Folic acid Keep out of the reach of children, protected from moisture and light at a temperature of 15 0 C -25 0 C.
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