How much folate when pregnant

Folic acid

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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

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Centers for Disease Control and Prevention (CDC)
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Last reviewed: May 2020

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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

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home » About clinic » Folic acid when planning pregnancy

Any woman who plans to soon become pregnant and become a mother should consciously and carefully prepare for this new status. And if everyone knows about a healthy lifestyle, parting with bad habits and walking in the fresh air, then expectant mothers often ignore the intake of certain vitamins and medicines before pregnancy. One such remedy is folic acid.

What is folic acid?

Folic acid is vitamin B9. Often you can hear the generalized name - folates, they are derivatives of this vitamin. We must understand that we get them from food, and folic acid tablets are a synthetic agent that is already converted into folates inside the body.

All derivatives of vitamin B9 play an important role in hematopoiesis, that is, the formation of new blood cells. Therefore, the lack of these substances leads to anemia - a condition in which there are not enough red blood cells, or they are irregular in shape and do not perform their functions. Folates have another very important feature: they stimulate the formation of nucleic acids (DNA and RNA), which are the basis of all body cells. Therefore, it is folic acid that is necessary for all rapidly dividing human tissues, including embryonic tissues.

The role of folic acid:

participates in the formation of DNA in all cells, that is, the source of hereditary information;
stimulates hematopoiesis;
indirectly blocks the formation of cancer cells;
restores muscle tissue;
during pregnancy: plays a role in the laying and development of the nervous tissue of the embryo, participates in the formation of placental vessels.

Why do you need folate during pregnancy?

During pregnancy, especially in the early stages, the consumption of folate increases dramatically. All cells of the embryo are intensively dividing in order to eventually form full-fledged tissues. The nervous tissue of the future man is transformed especially quickly and difficultly. And it is she who requires a large amount of folic acid.

Folic acid deficiency during pregnancy can occur due to the following reasons:

Insufficient intake of folate from food.
Folate malabsorption (in chronic inflammatory diseases of the stomach and intestines).
Genetic disorders of the folate cycle. In rare cases, a woman's body lacks the necessary enzymes (MTHFR). As a result, folic acid is not converted to folates, and they do not perform the necessary functions. Intermediate metabolic products accumulate in the body, which can lead to cardiovascular diseases, tumor processes, infertility and miscarriage. In the presence of such a mutation, it is recommended to take folic acid derivatives, for example, Metafolin. It is absorbed faster and in greater volume.
Taking certain anti-epilepsy drugs and hormonal drugs dramatically reduces blood folate levels:

oral contraceptives;
barbiturates, diphenylhydantoin;
sulfa drugs (for example, biseptol), which inhibit the synthesis of vitamin B9 by the intestinal microflora;
drinking alcohol also lowers their levels.

At what stage of pregnancy should I take folic acid supplements?

Folic acid intake to prevent fetal malformations should be started already at the stage of preparation for pregnancy, at least three months before the intended conception. That is why pregnancy should be planned. If conception occurred unexpectedly, then you need to start taking the drug as soon as it became known.

Reasons for taking folates at the stage of pregnancy planning:

If a woman has an unbalanced diet, her folic acid level can be low, so it takes time to replenish her reserves. It usually takes three to four months.
The neural tube of the fetus is laid at such an early stage that a woman may not even be aware of the pregnancy, especially with a long menstrual cycle.
Folate deficiency can make pregnancy difficult.

Doctors of the Intime Family Planning Clinic give the following recommendations for taking folic acid: in most cases, three months before conception and throughout pregnancy, you need to take 400 micrograms of folic acid per day. In some cases, the dosage is advised to increase: up to 1 mg per day for epilepsy and diabetes; up to 4 mg per day if there have been children with neural tube defects in the past Increased doses of folates can only be prescribed by a doctor after a thorough examination. The dose of folic acid during pregnancy remains the same.

We wish you an easy pregnancy and healthy babies!

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What is folic acid and why it is used

folic acid - B vitamin B vitamin of B. Folic acid can be used:

for treatment:

Folic -deficing anemia caused substances (for example, with celiac disease or a digestive disorder called sprue) or with an increased body need for this vitamin (for example, during pregnancy).

for the prevention of:

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:

are allergic (hypersensitive) to folic acid packaging and additional information),
untreated vitamin B deficiency ₁₂ eg in certain types of anemia and in vegetarians.
pernicious anemia (a form of anemia caused by vitamin B12 deficiency) or other conditions caused by vitamin B deficiency ₁₂ .
malignant tumor.

Talk to your doctor or pharmacist before taking Folic Acid if:

you have a folate dependent tumor,
You are pregnant,
you have a disease that is accompanied by a decrease in the level of vitamin B ₁₂ in the body.

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:

antiepileptic drugs (for the treatment of epilepsy), such as phenytoin, phenobarbital or primidone,
antibiotics (to treat infections), such as chloramphenicol and co-trimoxazole,
sulfasalazine (for ulcerative colitis, Crohn's disease, or rheumatoid arthritis),
methotrexate (to treat Crohn's disease, psoriasis, or rheumatoid arthritis).

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 directed 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):

for the treatment of folic -deficiency anemia: 5 mg per day (5 tablets of 1 mg) within 4 months, which can be, which can be, which may be increased to a maximum of 15 mg per day.

To prevent folic acid deficiency caused by certain drugs: 5 mg daily (5 x 1 mg tablets) for 4 months, which may be increased to a maximum of 15 mg daily.

To prevent folic acid deficiency caused by prolonged destruction of red blood cells (hemolytic anemia) or kidney dialysis: 5 mg (5 x 1 mg tablets) every 1 to 7 days.

To prevent the development of fetal neural tube defects (eg, spina bifida) in women with an increased risk of developing it in the fetus: 5 mg (5 x 1 mg tablets) the day before the expected pregnancy, continue through the first trimester pregnancy.

For the treatment of folic acid deficiency during pregnancy: 5 mg (5 x 1 mg tablets) per day to continue until the baby is born.

Children:

For young children, it is recommended to use a more convenient dosage form of the drug.

For the treatment of folate deficiency anemia: Children 1-18 years: 5 mg daily (5 x 1 mg tablets) for 4 months. The maintenance dose is 5 mg every 1-7 days.
For the treatment of hemolytic anemia and metabolic disorders: Children 1-12 years: 2.5 mg - 5 mg once a day (2.5 - 5 tablets of 1 mg).

Children 12-18 years: 5 mg - 10 mg once a day (5 - 10 tablets of 1 mg).

To prevent folate deficiency in renal dialysis: Children 1-12 years: 250 mcg/kg body weight (up to a maximum of 10 mg) (up to 10 1 mg tablets) per day.

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, call emergency services right away 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 in 10,000 but less than 1 in 1,000 people):

Allergic reaction (hypersensitivity) eg skin itching/redness, rash.
Severe allergic reaction (anaphylactic reaction): swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing, shock (cold, wet skin, weak pulse, dry mouth, dilated pupils).
From the gastrointestinal tract : loss of appetite, nausea, bloating, flatulence.

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".