Folic acid: how much and when to take
Short on time? Then the key things to know are:
- Folic acid is the man-made formulation of folate, or vitamin B9 - in pregnancy it helps the baby’s brain, skull and spinal cord to develop fully
- Women need up to 10 times more folic acid to support their developing baby during pregnancy -Taking folic acid can help to reduce the risk of defects such as spina bifida, heart or limb defects and childhood brain tumours
- Folic acid is needed during the first 12 weeks of pregnancy and can be bought over the counter at most pharmacies or supermarkets
Most of us have heard the term ‘folic acid’. But what actually is it? And why is it recommended during pregnancy?
Here we share everything you need to know about folic acid including how much you should take and when.
Why is folic acid important?
Overall, eating a healthy, balanced diet throughout your pregnancy will ensure you get most of the vitamins and minerals you need. They are required to ensure healthy growth and development of the growing baby. However in the UK, it can be common to be low in vitamin D (which comes from the sun) and folic acid.
Both of these vitamins are important in pregnancy (or when trying to conceive) and it is important to take extra supplements of these when pregnant, or when thinking about becoming pregnant.
What is folic acid?
Folic acid is the man-made formulation of folate (vitamin B9). Folate ensures that the body makes healthy red blood cells, and in pregnancy it helps the baby’s developing brain, skull and spinal cord.
Taking folic acid in pregnancy will reduce the risk of neural tube defects in the developing foetus, such as spina bifida. It can also reduce the risk of heart or limb defects and childhood brain tumours.
As well as taking a folic acid supplement, try to eat foods rich in folate (the naturally occurring form of folic acid) throughout pregnancy. Folate is found in green leafy vegetables (such as cabbage, spring greens and spinach), chickpeas and kidney beans, broccoli, fortified breakfast cereals and some fat spreads. It is unlikely, however, that diet alone will give you enough folic acid without taking a supplement during pregnancy.
What about side effects?
Side effects from taking folic acid supplements are not very common. However, some people may experience bloating, nausea and loss of appetite. These effects are usually mild and short-lived. There are no known harmful effects to the developing baby of taking folic acid supplements.
When should you take folic acid? And how much?
During pregnancy, women need up to 10 times more folic acid to support the developing baby. It is recommended that all women trying to conceive, and up to 12 weeks pregnant, take 400 micrograms of folic acid per day. This is to reduce the risk of any complications with the development of the baby in those early weeks.
If you have not taken folic acid before conception, start taking it as soon as you have found out you are pregnant. Some women may be advised to take a higher dose of folic acid - the reasons for which are detailed below.
Generally, the only vitamin supplement required after the 13th week of pregnancy is vitamin D. However, taking folic acid into the second and third trimesters at 400 micrograms per day will not be harmful to you or your baby. Indeed, if you are taking a pregnancy multivitamin containing folic acid and vitamin D it is safe to continue these throughout all 3 trimesters.
Evidence that folic acid is needed in pregnancy
Many scientific studies have shown that folic acid is needed during the first 12 weeks of pregnancy to support the normal development of the foetus. This is because during this time, the majority of the baby’s internal organs are formed.
Neural tube defects
The baby’s neural tube starts forming in the first four weeks of pregnancy (before the first missed period) and so it is best to start taking folic acid before trying to become pregnant, or as soon as you find out you are pregnant. Before it was advised to take folic acid during pregnancy, approximately 1 in 200 pregnancies in the UK and Ireland resulted in a baby with a neural tube defect, whereas now, in women taking supplements this risk is reduced to 1 in 400.
Cleft lip and palate
Some studies have shown there is a reduced risk of a baby having cleft lip and palate if you have taken folic acid in early pregnancy. Other studies have shown there is no link. More research is needed in this area, and it may be that only certain types of cleft lip/palate are linked to folate deficiency.
Urinary tract defects
One study has shown there is a reduced risk of deformities in the urinary tract (bladder and kidneys) of the developing baby in women taking folic acid supplements. Further research in this area is needed to evidence this.
Miscarriage, stillbirth, preterm birth and low birth weight
Most studies have shown there is no link between folate deficiency and these pregnancy outcomes. There is no scientific evidence of any harmful effects on the foetus.
Of note, up to 1 in 5 pregnancies end in miscarriage, and in 1 in 40 there is a birth defect. These are background population risks, and can happen in any pregnancy, independent of the mother’s health, genetic background, medication and lifestyle.
Taking higher doses of folic acid
Some women will need to take higher doses of folic acid. If you have a higher risk of having a baby with spina bifida or neural tube defects, then it is advised to take a daily dose of 5 milligrams of folic acid. As this is higher than normal, it will need to be prescribed by a doctor.
Your GP, midwife, or healthcare professional may advise an increased dose if:
- You have had a previous pregnancy affected by a neural tube defect (like spina bifida)
- You or your partner have a neural tube defect, or a family history of a neural tube defect
- You are on certain medications for epilepsy, or HIV
- You have diabetes or coeliac disease
- You have a high body mass index (BMI) over 30
In these scenarios your midwife or GP may also recommend extra screening in your pregnancy.
What if I forget to take it?
Missing a day or two of folic acid will unlikely be a problem. However, if you feel you are getting side effects, or want to stop taking it, it is advisable to speak with your healthcare professional. If you do not take it in the first 12 weeks of being pregnant, then the risk of neural tube defects in your baby may increase.
If you do forget to take a dose, you can take the tablet when you do remember. If this time is near to the time of your next dose, just skip it and take your next dose as normal. It is not advised to take two doses to make up for this missed one. Sometimes, an alarm on your phone or setting another reminder can help if you find you are forgetting doses often.
If you accidentally take too much folic acid it is unlikely to be harmful. If you are concerned, though, speak with your midwife, doctor or pharmacist.
It is best to take folic acid supplements at a time of day that you are most likely to remember it. But it is recommended you take it with your main meal of the day if possible.
##Where to get folic acid supplements
Folic acid supplements are widely available to purchase over the counter in pharmacies and supermarkets. Indeed, as it also recommended to take vitamin D, many women like to take a ‘pregnancy’ multivitamin which will contain the recommended daily amounts of folic acid as well as others. It is important, however, not to take a multivitamin containing vitamin A (retinol) as this can be damaging to the developing baby.
If you qualify for the [healthy start scheme[(https://www.healthystart.nhs.uk/), you may be able to get pregnancy vitamins for free.
For more information about healthy eating before and during pregnancy, and while breastfeeding take a look at the [NHS Choices – Your Pregnancy and Baby Guide](www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy- and-baby-care.aspx#close).
This leaflet also has further information on the best use of medicines in pregnancy.
Looking for one-to-one support for your pregnancy concerns? Book a consultation with our private midwives who can provide specialist advice at a time that suits you.
Dr Aynsley Cresswell, Naytal Medical Advisor
Dr Aynsley Cresswell is an experienced GP with a special interest in women’s sexual health, and obstetrics and gynaecology.