Folic acid recommendations for pregnancy

Folic acid | March of Dimes

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

How much folic acid do you need?

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

CDC

Show Your Love Preconception Health

Last reviewed: May 2020

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

what you need to know, why you need it during pregnancy

In 1931, the English physician and scientist Lucy Wills decided to prescribe brewer's yeast extract to pregnant women with anemia. After a short time, the condition of the patients improved markedly. Scientists have long tried to understand what kind of healing component helped them.

Thanks to the improvement of technologies for extraction and isolation of substances in the form of crystals, it was possible to identify the secret component. In 1941, a team of scientists led by Professor Mitchell managed to get what they were looking for from spinach leaves. It turned out that this is an organic acid, which was called folic acid (from the Latin folium - "leaf").

What you need to know about folic acid

Folic acid (or vitamin B9) is a water-soluble vitamin that is essential for many vital processes. Bacteria synthesize it in small amounts in the body, but most of it comes from food. These are leafy vegetables, seaweed, nuts, sunflower seeds, etc.

Among the main functions of folic acid are:

participation in the processes of cell division during the period of active growth and development in childhood and adolescence;
participation in DNA synthesis;
stimulation of hematopoiesis;
participation in metabolic processes.

Help: what are water-soluble and fat-soluble vitamins

Water-soluble vitamins are eliminated from the body naturally within a few hours. Therefore, you need to use them regularly. As for fat-soluble ones, they can be deposited, for example, in the liver. Among these are vitamins A, E, K, D.

Benefits of folic acid for women

For a woman, folic acid is one of the essential components to maintain youth. Sufficient consumption of this vitamin promotes tissue regeneration, maintaining skin firmness and elasticity.

B9 is also essential for successful conception. He takes part in the maturation of female germ cells (oocytes), implantation and the formation of the placenta.

Important! Folic acid isn't just for women. Vitamin B9takes an active part in spermatogenesis - the formation of male germ cells (spermatozoa). Therefore, for successful conception, both partners need a sufficient level of its consumption. It's over 200 micrograms. per day.

Why folic acid is so important during pregnancy

Pregnant women need more vitamin B9. The World Health Organization (WHO) recommends taking at least 400 micrograms of folic acid per day during pregnancy. This is most important in the first trimester, when the organs of the future baby are laid. For their development, it is necessary to ensure intensive cell division, which requires a large amount of folate. This is especially true of the neural tube of the fetus, from which the brain and spinal cord are then formed.

Lack of vitamin B9 in the diet can lead to serious adverse effects on the fetus, including:

malformations of the nervous system;
heart defects;
increased risk of developing Down syndrome;
vascular disorders.

Taking folic acid (and other vitamins and minerals) in the first half of pregnancy is also justified by the woman's relatively poor appetite. This happens against the background of toxicosis. Due to malnutrition, there is a shortage of biologically active substances necessary for mother and fetus.

Note that a pregnant woman needs not only folic acid, but also other B vitamins (B1, B2, B6, B12), vitamins A, D, E, C, biotin and minerals. Therefore, expectant mothers are often prescribed special complexes, for example, Elevit *, Complivit, Multi-tabs and others. Such preparations contain several vitamins and minerals at once, which are necessary for maintaining a healthy pregnancy. Folic acid is also available separately, mainly in the form of tablets - Foliber, Folacin and others.

Folic acid intake during pregnancy and lactation is important to coordinate with your doctor, who will determine the need for prescribing the drug and dosage. The drug is contraindicated in the absence of an established deficiency of vitamin B9, individual intolerance, malignant tumors, as well as pernicious anemia without additional intake of vitamin B12.

*dietary supplement. Not a drug

Vitamins and pregnancy - articles from the specialists of the clinic "Mother and Child"

Kurbatskaya Olga Nikolaevna

Obstetrician-gynecologist

Lapino-1 Clinical Hospital "Mother and Child"

One of the most common questions that pregnant women ask their doctor is what vitamins should I take during pregnancy? Let's say right away whether expectant mothers need to drink pharmaceutical vitamins or not - there is no unequivocal answer to this question. Some doctors believe that the necessary nutrients should be obtained from natural products. Others are in favor of taking pharmaceutical multivitamins. It can only be said unequivocally that vitamins and microelements must necessarily enter the body of a pregnant woman. We will tell you which of them are most important for the expectant mother.

Folic acid

Other names for this vitamin are vitamin B ₉ or B _with. This vitamin is necessary for cell division and reproduction, so it is especially important in the first trimester of pregnancy, when all organs and systems of the child are being laid. Folic acid plays an important role in the synthesis of hemoglobin, and with its deficiency, anemia can develop. And folic acid also helps to reduce the likelihood of spinal defects in a child, takes care of the correct formation of his psyche and intellect. It is better to start taking folic acid three months before the planned conception, since a small supply of this vitamin will only be useful for both the expectant mother and the baby. If the pregnancy has come unplanned, then folic acid must be taken as soon as the woman finds out about her situation. On average, the dosage of this vitamin is from 0.4 to 0.8 mg per day.

Calcium

An expectant mother needs about 1200–1400 mg of calcium daily, while an ordinary woman needs 800–1000 mg of this trace element. Why? During pregnancy, the amount of calcium in the body of the expectant mother is significantly reduced, since it is also spent on the growth and development of the child. Especially a lot of calcium is needed in the third trimester, when the baby's skeleton is calcified. But calcium is needed not only for the growth of bones and teeth of a child - with its help, his nervous system, his heart, muscles, skin tissues, eyes, ears, hair and nails are formed. A pregnant woman needs calcium for the full functioning of the kidneys, the prevention of muscle pain, constipation, osteoporosis, caries and toxicosis. In addition, this trace element protects the expectant mother from stress and nervous overload.

Vitamin E

This vitamin is involved in the process of tissue respiration, it helps oxygen to penetrate into every cell of the body. At the same time, vitamin E is an excellent antioxidant: it protects cells from the formation of free radicals that can provoke various diseases. This protective function is especially important at the stage of embryo formation. In addition, vitamin E helps to normalize the hormonal balance of the body. In the early stages, it participates in the formation of the placenta, and also protects against abortion. The dose of vitamin E during pregnancy is 15 mg.

Vitamin E is found in vegetable oils, not less than this vitamin in lettuce, tomatoes, rose hips, parsley, spinach and peas. Some vitamin E is found in meat, eggs and milk.

Magnesium

Magnesium is involved in all metabolic processes, helps to cope with stress, normalizes the functioning of the cardiovascular system and blood pressure, and keeps blood vessels in good shape. Due to a lack of magnesium in the body, cramps in the muscles (usually in the calves) may appear. And since the uterus is also a muscular organ, with a lack of magnesium during pregnancy during gestation, the excitability of the myometrium increases, which leads to active uterine contractions. Therefore, with hypertension and the threat of abortion, magnesium is often prescribed.

Magnesium is rich in whole grains and whole grain breads, figs, almonds, seeds, dark green vegetables, and bananas.

iodine

Iodine is usually prescribed for pregnant women in the first trimester. Up to 16 weeks of pregnancy, the development of the child and the laying of all its organs and systems are "under the protection" of the mother's thyroid gland. And if a woman has little iodine, then this means that some system or organ of the baby may suffer. And even when the child’s own thyroid gland is formed and starts working, she can still take iodine only from the mother’s body. Its daily dose is 250 mg per day.

Iodine is easiest to get from seafood and sea or iodized salt. A lot of iodine is found in sea fish, seaweed, squid, persimmon, feijoa, dates, dried figs, dairy products and meat. However, iodine is destroyed by temperature effects, which means that after heat treatment, the amount of iodine in the products decreases sharply.

Iron

Iron is necessary primarily for the prevention of anemia. After all, it is part of hemoglobin, which carries oxygen throughout the body of the mother and child. In addition, iron is involved in protein synthesis, which is involved in the formation of muscle tissue. And iron deficiency can lead to increased uterine tone. The average daily dosage of iron is 30–60 mg. In some cases, if the woman's iron supply was initially reduced, the dosage may be higher.

Iron is found in meat, especially a lot of it in veal, turkey, hare, pork and beef. There is iron in plant foods, but from there it is absorbed much worse. Iron is best absorbed when taken together with vitamin C.

If a pregnant woman eats properly and varied, eats a lot of fruits and vegetables, then she may not need an additional complex of vitamins for pregnant women. It may be necessary to drink some vitamins separately, but this should be determined by the doctor. If, before pregnancy, a woman had signs of vitamin deficiency, she eats incorrectly or poorly, then multivitamins cannot be dispensed with.

Inset

Vitamin B ₉ (folic acid) is found in animal liver, spinach, asparagus, lentils, Brussels sprouts, beans and wholemeal flour. However, it is absorbed very poorly from food, no more than 50%. That is why it is prescribed to almost all pregnant women.

At one time, our body will not be able to absorb more than 500 mg of calcium. Therefore, you should not try to get the entire daily norm of this trace element in one meal. Try to eat foods containing calcium in small portions several times a day.

To increase the concentration of magnesium in tissues, vitamin B ₆ (pyridoxine) is needed, which facilitates its absorption and acts as a conductor of magnesium into the cell. Therefore, magnesium and vitamin B ₆ are often prescribed together.

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