Should i take folic acid while pregnant

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

Vitamins, minerals and supplements in pregnancy

Eating a healthy, varied diet in pregnancy will help you get most of the vitamins and minerals you need.

But when you're pregnant, or there's a chance you might get pregnant, it’s important to also take a folic acid supplement.

It's recommended that you take:

• 400 micrograms of folic acid every day – from before you're pregnant until you're 12 weeks pregnant

This is to reduce the risk of problems in the baby's development in the early weeks of pregnancy.

It is also recommended that you take a daily vitamin D supplement.

Do not take cod liver oil or any supplements containing vitamin A (retinol) when you're pregnant. Too much vitamin A could harm your baby. Always check the label.

You also need to know which foods to avoid in pregnancy.

Where to get pregnancy supplements

You can get supplements from pharmacies and supermarkets, or a GP may be able to prescribe them for you.

If you want to get your folic acid from a multivitamin tablet, make sure the tablet does not contain vitamin A (or retinol).

You may be able to get free vitamins if you qualify for the Healthy Start scheme.

Find out more about the Healthy Start scheme.

Folic acid before and during pregnancy

It’s important to take a 400 micrograms folic acid tablet every day before you're pregnant and until you're 12 weeks pregnant.

Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.

If you did not take folic acid before you conceived, you should start as soon as you find out you're pregnant.

Try to eat green leafy vegetables which contain folate (the natural form of folic acid) and breakfast cereals and fat spreads with folic acid added to them.

It's difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it's important to take a folic acid supplement.

Higher-dose folic acid

If you have a higher chance of your pregnancy being affected by neural tube defects, you will be advised to take a higher dose of folic acid (5 milligrams). You will be advised to take this each day until you’re 12 weeks pregnant.

You may have a higher chance if:

• you or the baby's biological father have a neural tube defect
• you or the baby's biological father have a family history of neural tube defects
• you have had a previous pregnancy affected by a neural tube defect
• you have diabetes
• you take anti-epilepsy medicine
• you take anti-retroviral medicine for HIV

If any of this applies to you, talk to a GP. They can prescribe a higher dose of folic acid.

A GP or midwife may also recommend additional screening tests during your pregnancy.

Find out about epilepsy and pregnancy.

Vitamin D in pregnancy

You need 10 micrograms of vitamin D each day and should consider taking a supplement containing this amount between September and March.

Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. Our bodies make vitamin D when our skin is exposed to summer sunlight (from late March/early April to the end of September).

It's not known exactly how much time is needed in the sun to make enough vitamin D to meet the body's needs, but if you're in the sun take care to cover up or protect your skin with sunscreen before you start to turn red or burn.

Vitamin D is also in some foods, including:

• oily fish (such as salmon, mackerel, herring and sardines)
• eggs
• red meat

Vitamin D is added to some breakfast cereals, fat spreads and non-dairy milk alternatives. The amounts added to these products can vary and might only be small.

Because vitamin D is only found in a small number of foods, whether naturally or added, it is difficult to get enough from foods alone.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.

You can get vitamin supplements containing vitamin D free of charge if you're pregnant or breastfeeding and qualify for the Healthy Start scheme.

Information:

There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19). But there is currently not enough evidence to support taking vitamin D solely to prevent or treat COVID-19.

If you have dark skin or cover your skin a lot

You may be at particular risk of not having enough vitamin D if:

• you have dark skin (for example, if you're of African, African Caribbean or south Asian origin)
• you cover your skin when outside or spend lots of time indoors

You may need to consider taking a daily supplement of vitamin D all year. Talk to a midwife or doctor for advice.

Iron in pregnancy

If you do not have enough iron, you'll probably get very tired and may suffer from anaemia.

Lean meat, green leafy vegetables, dried fruit, and nuts contain iron.

If you'd like to eat peanuts or foods that contain peanuts (such as peanut butter) during pregnancy, you can do so as part of a healthy, balanced diet unless you're allergic to them or your health professional advises you not to.

Many breakfast cereals have iron added to them. If the iron level in your blood becomes low, a GP or midwife will advise you to take iron supplements.

Vitamin C in pregnancy

Vitamin C protects cells and helps keep them healthy.

It's found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.

Good sources include:

• oranges and orange juice
• red and green peppers
• strawberries
• blackcurrants
• broccoli
• brussels sprouts
• potatoes

Calcium in pregnancy

Calcium is vital for making your baby's bones and teeth. 

Sources of calcium include:

• milk, cheese and yoghurt
• green leafy vegetables, such as rocket, watercress or curly kale
• tofu
• soya drinks with added calcium
• bread and any foods made with fortified flour
• fish where you eat the bones, such as sardines and pilchards

Vegetarian, vegan and special diets in pregnancy

A varied and balanced vegetarian diet should provide enough nutrients for you and your baby during pregnancy.

But you might find it more difficult to get enough iron and vitamin B12.

Talk to a midwife or doctor about how to make sure you're getting enough of these important nutrients.

If you're vegan or you follow a restricted diet because of a food intolerance (for example, a gluten-free diet for coeliac disease) or for religious reasons, talk to a midwife or GP.

Ask to be referred to a dietitian for advice on how to make sure you're getting all the nutrients you need for you and your baby.

Find out more about healthy eating if you're pregnant and vegetarian or vegan.

Healthy Start vitamins

The Healthy Start scheme may be able to help you buy food and milk if you're pregnant or have a child under 4 years old and receive certain benefits, or you’re pregnant and under 18.

If you’re eligible, you’ll be sent a Healthy Start card which you can use to buy certain types of milk, infant formula, fruit and vegetables.

You can also use your card to get free vitamins.

If you're not eligible for the Healthy Start scheme, some NHS organisations still offer the vitamins for free, or sell them. Ask a midwife about what's available in your area.

More information:

• Read more information about Healthy Start, or apply for a Healthy Start card, on the Healthy Start scheme website
• Read more about getting vitamins on the Healthy Start scheme website

Video: Should I take supplements during my pregnancy?

In this video, a midwife explains which supplements you can take during pregnancy.

Media last reviewed: 5 February 2020
Media review due: 5 February 2023

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Folic acid for pregnancy planning

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

Albitskaya Elena Vladimirovna

Ultrasound doctor

Clinical hospital Lapino-1 "Mother and Child"

One of the most frequent questions that pregnant women ask their doctor is what vitamins should be taken 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 _c . 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 work of the cardiovascular system and blood pressure, keeps the 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 found in whole grains and whole grain breads, figs, almonds, seeds, dark green vegetables and bananas.

iodine

Pregnant women are usually prescribed iodine 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 most easily obtained 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 needed 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 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) 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 magnesium concentration 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.