Why Is Folic Acid Important for Pregnancy?

If you are pregnant or considering getting pregnant, you've probably been told to get enough folic acid. Folic acid is a vitamin found in food and also taken in supplement form. It's vital for fetal development, especially in the first trimester of pregnancy.

It's common to have questions and concerns about folic acid in pregnancy. You may want to know why it's important to get enough folic acid, and how being deficient could potentially impact your fetus' development. Also, how much folic acid should you take? When should you start taking it, and what's the best way to consume it?

We reached out to three OB-GYNs to clarify your most pressing questions about folic acid in pregnancy.

What Is Folic Acid?

Folic acid is a kind of B vitamin that all humans need. It's used to generate new red blood cells in our bodies. When you don't have enough blood cells, you can develop anemia. Folic acid is found naturally in leafy green vegetables, fruits, and nuts. It's used as a fortifier in foods like bread and breakfast cereal, and it's a component of many vitamin supplements.

Sometimes the terms "folate" and "folic acid" are used to mean the same thing, but they are not the same. Folate refers to B vitamins that occur naturally in foods, whereas folic acid is a manufactured form of folate that is used as a food fortifier or in vitamin supplements. Both types are healthy and helpful for you to consume.

Why Do Doctors Prescribe Folic Acid Before and During Pregnancy?

Everyone needs to maintain adequate folic acid intake, but it's especially important for pregnant people, or those who hope to become pregnant in the future. Folic acid is fundamental for normal baby neurological development, explains Amy Wetter, M.D., board-certified OB-GYN at Pediatrix Medical Group in Atlanta, Georgia. "Folic acid aids in the formation of the neural tube, which becomes the early brain and spine," she adds. "Adequate levels of folic acid can help prevent birth defects of the brain and spine."

In addition to preventing neural tube defects, folic acid can help reduce the risk of birth defects like cleft lip and palate, says Anisha Farishta, M.D., an OB-GYN affiliated with Memorial Hermann Sugar Land Hospital. "Folic acid also supports the growth and development of the placenta, which provides nutrients and oxygen to the baby and may also play a role in preventing pregnancy complications such as preterm labor and preeclampsia," notes Dr. Farishta.

When to Take Folic Acid Supplements

Most people think of folic acid supplementation as something to be started as soon as you become pregnant, but it's advised that you begin supplementing even before conception, says Maggie Richter, M.D., an OB-GYN with McGovern Medical School at UTHealth Houston. "Folic acid supplements are recommended for at least one to three months prior to becoming pregnant and then throughout the duration of the pregnancy," she says. That said, supplementation is most important during the first six to eight weeks of pregnancy, when the neural tube is forming, notes Dr. Richter.

Because not all people who become pregnant plan their pregnancies, Dr. Richter recommends that anyone who is not using contraception or who is at risk of an unplanned pregnancy take a folic acid supplement as well.

How Much Folic Acid Should You Take?

According to the American College of Obstetricians and Gynecologists (ACOG), pregnant people should consume approximately 600 micrograms of folic acid daily. Because it can be hard to get folic acid from food alone, medical experts recommend taking a daily prenatal vitamin with at least 400 micrograms of folic acid starting at least one month before pregnancy. Additionally, you can focus on making sure to consume foods with high folate content.

Prior to pregnancy, it's advised to consume 400 micrograms of folic acid daily; however, there are some individuals who should take more. People who may need more folic acid include those whose previous pregnancies were affected by a neural tube defect or people on certain medications, explains Dr. Farishta. "It's important to talk to a health care provider about the recommended dosage of folic acid that is right for you," she adds.

Who Shouldn't Take Folic Acid?

There are very few scenarios where folic acid supplementation is cautioned against. "Most people can take folic acid unless you have had an allergic reaction to it in the past," says Dr. Wetter. Additionally, people with a history of certain types of cancers, those who have had seizures, and those with vitamin B12 deficiencies may need to avoid folic acid supplements, notes Dr. Farishta.

"As with any medication or supplement, it's important to talk to a health care provider so they can help you make an informed decision," advises Dr. Farishta.

Best Ways to Take Folic Acid During Pregnancy

Again, ACOG recommends that pregnant people consume folic acid both in supplement form and in food fortified with folic acid, as well as fruits and veggies that are rich in folate.

As for vitamins, you can take any vitamin supplement that you can stomach—and it's totally common to be sickened by swallowing vitamins during early pregnancy, so just go with whatever works best for you. "Most vitamins, whether prenatal or multivitamins, have 400 mcg of folic acid so they are typically the best way to ensure you are getting the recommended daily amount," says Dr. Wetter.

As for food sources, there are lots of choices as well, especially for someone who's dealing with a bout of food aversion or morning sickness. You can't go wrong with breads, cereals, pastas, rice, flour, and most other grains, because the FDA requires these to be fortified with folic acid. For other processed foods, look at the food label to see whether folic acid is an ingredient.

There are also many foods that are sources of folate, the naturally occurring form of folic acid. These include dark, leafy greens (such as spinach and kale), oranges, bananas, lentils, black-eyed peas, avocados, asparagus, beef liver, and Brussels sprouts.

If you have any further questions about folic acid during pregnancy, including any recommendations for particular supplements, please reach out to an OB-GYN or health care provider.