A SciMoms Guide to Folate and Folic Acid in Pregnancy
If you’re planning to get pregnant, it’s important to start taking folic acid at least one month before you conceive in order to ensure your baby’s healthy neurodevelopment. While we don’t know the exact role of folic acid in pregnancy, we know that folic acid is essential for healthy tissue formation. During the first few weeks after conception, the fetus develops its neural tube, which later forms the baby’s spinal cord, spine, brain, and skull. If the neural tube doesn’t close properly during formation, the developing brain or spinal cord could be exposed to amniotic fluid, potentially causing serious and debilitating neural tube defects like spina bifida and anencephaly. In this post, we outline CDC recommendations on folic acid supplementation.
Why do I need to start taking folic acid before I get pregnant?
According to the CDC, getting the daily recommended amount of folic acid into your system a month before the start of your first trimester can reduce the risk for neural tube defects by 50 to 70 percent. This timing of when you take folic acid in pregnancy is crucial because neural tube formation occurs very early. Most women do not know they are pregnant until after neural tube formation has occurred.
How much folic acid should I take?
The CDC and the American College of Obstetrics and Gynecology recommend that anyone planning to get pregnant take 400 micrograms (mcg) of folic acid daily, in addition to eating a healthy diet with foods containing folate. For pregnant women who have previously given birth to a baby with a neural tube defect, the CDC recommends taking much more: 4 milligrams (4,000 mcg) of folic acid per day.
People of childbearing age who are Hispanic or Latina are more likely to have kids with neural tube defects compared to non-Hispanic people. According to the CDC, this population group has lower levels of folate in their blood compared to non-Hispanic white women and are less likely to get folic acid from fortified foods or to take a multivitamin with folic acid in it. In addition, they are more likely than non-Hispanic white women and non-Hispanic Black women to have a MTHFR gene variant that is associated with lower blood folate levels and increased risk of neural tube defects (more on the MTHFR variant below).
What’s the difference between folic acid and folate?
Folate is a general term used to describe different forms of vitamin B9, an essential nutrient that the body can’t make on its own. Folic acid, on the other hand, is the synthetic form of folate used to fortify foods and to make supplements like prenatal vitamins. Your body converts both folate and folic acid to the active form of vitamin B9.
Can’t I just eat lots of leafy greens?
Leafy greens, citrus fruits, and beans all contain natural folate, and all are nutritious options if you’re pregnant. However, according to the CDC, it’s very difficult for people of childbearing age to get the daily recommended amount of folate through food alone. That’s why you need that extra 400 mcg of folic acid in pregnancy.
Fortified foods are also a good source of folate. In the late 1990s, the FDA began requiring food companies to add folic acid to flour and flour-based products. The CDC estimates that this change prevents neural tube defects in an average of 1,300 babies each year who would have otherwise been affected. But because fortified foods haven’t been enough to prevent all neural tube birth defects, the CDC recommends that anyone planning to get pregnant take a daily prenatal vitamin containing the necessary amount of folic acid for pregnancy.
Yes, you need folic acid even if you have a MTHFR genetic variant
In recent years, some dangerous misinformation has circulated online about what role your genes play in your body’s ability to process folic acid.
As Undark reports:
Despite the scientific consensus, some nutritionists and dieticians — along with prominent complementary health practitioners including naturopaths, chiropractors, and functional medicine doctors — are causing many people, and not just those who are or may become pregnant, to question whether they should be consuming any folic acid at all. Many medical experts worry that these vocal individuals are urging people who could become pregnant to avoid vital folic acid supplementation, putting unborn babies at unnecessary risk for neural tube defects.
At the core of this misinformation is concern about the MTHFR gene or, more specifically, variants of this gene. According to the CDC, “the MTHFR gene provides instructions for your body to make the MTHFR protein, which helps your body process folate.” Variants in MTHFR, as well as other genes, are common and normal. Certain variants of this gene can lead to lower blood levels of folate and increased risk of neural tube defects. However, if you have this genetic variant of the MTHFR gene, your body can still effectively process all different types of folate. In fact, folic supplementation can help to mitigate the risk of neural tube defects, no matter which version of MTHFR you have. We also know that folic acid supplementation reduces the rate of neural tube defects in populations with both high and low frequency of the variant, meaning that this variant does not change whether supplementation works for preventing NTDs.
Some alternative health practitioners wrongly state that anyone with this variant should follow a special diet or avoid folic acid altogether. Other practitioners recommend, and often sell, alternative forms of folate for those with MTHFR variants. Specifically, they recommend L-methylfolate or “activated folic acid,” which is the chemical that MTHFR converts folic acid into. By taking “activated folic acid,” their faulty reasoning goes, you can “bypass” your MTHFR gene. But because folic acid is processed in a cycle, no matter where you add chemicals to that cycle, you cannot “bypass” MTHFR (and you don’t need to). These alternate forms of folate are more expensive with no added benefit.
That’s why, again, if you’re planning to get pregnant, you should follow the CDC recommendations for taking folic acid and take a prenatal vitamin that contains 400 mcg of folic acid at least a month before you get pregnant regardless of your MTHFR status.
In addition, as we have previously written in our post on genetic testing, if you are choosing to do genetic testing, medical action should never be taken based on a genetic test without consulting a genetic counselor.
Take your folic acid
The bottom line is folic acid is essential for everyone who might become pregnant. This critical supplement helps protect your baby’s healthy neurodevelopment. If you’re planning to get pregnant, start taking folic acid now. And if you have more questions about prenatal vitamins or prenatal nutrition, consider scheduling a preconception appointment to get all of your important questions about folic acid in pregnancy answered.
For more information and citations, consult these resources:
- CDC: What are neural tube defects (NTDs)?
- CDC: Folic Acid Q&A
- CDC: Folic Acid Recommendations for Women
- CDC: Information on Folic Acid Use to Help Prevent Neural Tube Defects
- MTHFR Gene, Folic Acid, and Preventing Neural Tube Defects
Dr. Attabey Rodriguez Benitez, Ph.D. (she/her/ella), is a biochemist, multimedia content creator, science writer, and editor. She completed her Ph.D. in Chemical Biology at the University of Michigan and was formerly a 2020 AAAS Mass Media Fellow at Science Friday. Now, she is the newest editor for the YouTube show SciShow where she shapes the channel’s content. You can find her on Instagram and Twitter, as ScienceBey where she shares content related to science communication.