Folic Acid: Importance Before and During Pregnancy

What is Folic Acid?

Folic acid is the synthetic form of vitamin B9, while folate is the natural form found in foods. Both perform the same functions in the body, but folic acid in supplements is more stable and easier to absorb at up to 85%, compared to 50% for natural folate from food.

Folic acid is a water-soluble vitamin that plays a vital role in many body functions, but its greatest importance lies in its essential role in DNA formation, cell division, and red blood cell production. These functions are particularly crucial during periods of rapid growth such as pregnancy and childhood.

Why is Folic Acid Critically Important During Pregnancy?

1. Preventing Neural Tube Defects

This is the most important and scientifically proven benefit. The neural tube is the structure that develops into the baby's brain and spinal cord, forming in the first weeks of pregnancy (usually weeks 3-4), often before a woman knows she's pregnant.

Folic acid deficiency during this critical period can lead to failure of the neural tube to close properly, causing serious birth defects:

• Spina Bifida: A condition where the spine doesn't close completely, which may cause partial or complete paralysis, bladder and bowel problems, and learning difficulties
• Anencephaly: A more serious condition where the brain doesn't develop fully, fatal in most cases
• Encephalocele: Part of the brain protrudes outside the skull

The scientific evidence is stunning: Studies have shown that taking folic acid before pregnancy and during the first months reduces the risk of neural tube defects by 50-70%. This is a medical discovery that has changed the lives of millions of children worldwide.

2. Preventing Other Birth Defects

In addition to neural tube defects, folic acid may help reduce the risk of:

• Congenital Heart Defects: Some studies showed a 25-30% reduction in some types of heart defects
• Cleft Lip and Palate: Slight reduction in risk
• Urinary Tract Defects
• Some Limb Defects

3. Preventing Pregnancy Complications

Adequate folic acid levels may reduce the risk of:

• Preeclampsia: A serious condition characterized by high blood pressure and organ damage
• Preterm Birth: Some research suggests folic acid may reduce risk of preterm birth
• Low Birth Weight
• Placental Abruption
• Recurrent Miscarriage: Especially in women with high homocysteine levels

4. Supporting Healthy Fetal Growth

• Essential for rapid cell division during fetal growth
• Important for proper placental development
• Supports DNA formation for new cells
• Helps form red blood cells for mother and fetus

When Should You Start Taking Folic Acid?

The Golden Rule: Start Before Pregnancy!

This is critically important: All women of childbearing age (15-45 years) should start taking folic acid at least one month before planning pregnancy, preferably 2-3 months before. The reason:

• The neural tube forms in weeks 3-4 of pregnancy
• Most women don't know they're pregnant until weeks 4-6
• By the time a woman discovers pregnancy, the critical period may have passed
• About 50% of pregnancies are unplanned

Recommended Timeline:

• Before Pregnancy: Start at least one month before trying to conceive (preferably 2-3 months)
• During Pregnancy: Continue until end of first trimester at minimum (some experts recommend continuing throughout pregnancy)
• After Birth: Preferably continue during breastfeeding to support mother's recovery and breast milk quality

Recommended Dosage

For Women at Standard Risk:

400 micrograms (0.4mg) daily

This dose is recommended by most global health organizations including WHO, American College of Obstetricians and Gynecologists, and health ministries in most countries.

For Women at High Risk:

5000 micrograms (5mg) daily

Higher dose recommended for women with one or more of the following risk factors:

• Previous Child with Neural Tube Defect: Recurrence risk is 2-5%, and high dose significantly reduces it
• Family History of Neural Tube Defects: One of the parents or siblings has history
• Taking Certain Medications: Such as epilepsy drugs (valproic acid, carbamazepine), methotrexate, some antimalarials
• Diabetes (Type 1 or 2): Especially if blood sugar control is poor
• Severe Obesity: Body mass index over 35
• Celiac Disease or Crohn's Disease: Affect folate absorption
• MTHFR Gene Mutation: Affects body's ability to metabolize folate

During Pregnancy After First Trimester:

Can continue 400 micrograms daily, or as found in comprehensive prenatal vitamins.

Sources of Folic Acid and Folate

Dietary Supplements (Folic Acid):

• Single Folic Acid Supplements: Available in 400, 800, 5000 microgram doses
• Prenatal Vitamins: Usually contain 400-800 micrograms plus other important vitamins and minerals
• Daily Multivitamins: Most contain 400 micrograms

Foods Rich in Natural Folate:

Despite the importance of supplements, eating folate-rich foods is an important part of a healthy diet:

• Dark Leafy Green Vegetables: Spinach (263 mcg/cooked cup), asparagus, romaine lettuce, broccoli
• Legumes: Lentils (358 mcg/cup), chickpeas, black beans, fava beans
• Citrus Fruits: Orange (50 mcg/orange), grapefruit
• Avocado: (90 mcg/half)
• Fortified Grains: Bread, pasta, rice fortified with folic acid
• Seeds and Nuts: Sunflower seeds, peanuts
• Eggs: (22 mcg/egg)
• Liver: Very rich source (215 mcg/85g) but advised to avoid during pregnancy due to high vitamin A content

Important Note: Folate in food is easily destroyed by heat and light. To preserve maximum amount: eat vegetables raw or lightly steamed, and store foods properly.

But Note: Even with an excellent diet, it's difficult to get 400 micrograms daily from food alone. Therefore supplements are essential for pregnant women or those planning pregnancy.

Folic Acid versus Methylfolate

There's another form of vitamin B9 that has become popular: methylfolate (L-methylfolate or 5-MTHF), the active form of folate that the body uses directly.

Main Difference:

• Folic Acid: Synthetic form that needs conversion in the body via MTHFR enzyme to become active
• Methylfolate: Active form ready for immediate use without need for conversion

Who May Benefit from Methylfolate?

• Women with MTHFR Gene Mutation: About 40-60% of people have some type of this mutation, reducing efficiency of converting regular folic acid
• Those with difficulty absorbing folic acid
• Those who prefer a more natural form

Note: Both forms are effective for preventing neural tube defects. Traditional folic acid is more studied and works excellently for most women. Consult your doctor or nutritionist if you're considering methylfolate.

Side Effects and Concerns

Side Effects (rare at recommended doses):

• Mild stomach upset or nausea (rare)
• Bitter taste in mouth
• Loss of appetite (very rare)
• Difficulty sleeping or irritability (very rare)

Most women don't experience any side effects when taking folic acid at recommended doses.

Can You Overdose?

Folic acid is water-soluble, meaning the body excretes excess amounts in urine, making dangerous overdose very rare. The safe upper limit for adults is 1000 micrograms daily from supplemental sources (supplements and fortified foods), with no limit for natural folate from food.

Concerns from Very High Doses (more than 1000 micrograms daily for long periods):

• Masking Vitamin B12 Deficiency: Very high doses may mask neurological symptoms of B12 deficiency, but this is rare and usually occurs at much higher doses
• Potential Drug Interactions: With some medications like epilepsy drugs and methotrexate

Important Note: The high dose of 5000 micrograms for high-risk women is completely safe and medically recommended. Concern is only for much higher continuous doses for long periods without medical need.

Other Benefits of Folic Acid (non-pregnancy)

Although its greatest importance is in pregnancy, folic acid has other health benefits:

• Heart Health: Lowers homocysteine levels, a risk factor for heart disease
• Preventing Anemia: Essential for red blood cell production
• Brain Health and Mood: Plays role in producing neurotransmitters, deficiency linked to depression
• Reducing Risk of Some Cancers: Especially colorectal cancer (research is mixed)
• Skin and Hair Health: Supports cell renewal

Practical Tips for Taking Folic Acid

• Make it Part of Your Daily Routine: Link taking it to a daily habit (like brushing teeth, breakfast) to ensure you don't forget
• Timing Doesn't Matter: Can be taken anytime during the day, with or without food
• With Other Vitamins: Completely safe to take with other prenatal vitamins, but check total dose
• Continue Even if Pregnancy is Delayed: No harm in continuing to take it
• Don't Stop Suddenly Upon Discovering Pregnancy: Continue until end of first trimester at least
• Tell Your Doctor: About all supplements you're taking

Prenatal Vitamins: The Comprehensive Option

Instead of taking folic acid alone, many women prefer comprehensive prenatal vitamins containing:

• Folic Acid: 400-800 micrograms
• Iron: To prevent anemia during pregnancy
• Calcium: For bone and teeth health
• Vitamin D: For calcium absorption and immune health
• Omega-3 (DHA): For fetal brain development (in some products)
• Other B vitamins, vitamin C, zinc, iodine

This is an excellent and more convenient option than taking several separate supplements.

Common Questions

What if I Didn't Take Folic Acid Before Pregnancy?

No need to panic! Start immediately upon discovering pregnancy. Although starting before pregnancy is optimal, taking it during the first weeks of pregnancy is still very beneficial. Most neural tube defects occur in weeks 3-4, so starting as early as possible is important.

Do Men Need Folic Acid?

Some research suggests folic acid may improve sperm quality and DNA health, but evidence isn't as strong as for women. However, no harm in men taking a multivitamin containing folic acid (400 micrograms) when planning pregnancy.

Conclusion

Folic acid is undoubtedly one of the most important supplements for women of childbearing age. Its scientifically proven ability to reduce neural tube defects by 50-70% has made it a universal public health recommendation. The simplicity, effectiveness, and low cost of this supplement make it an invaluable health investment.

Key Message: If you're of childbearing age and there's any possibility of pregnancy (even if unplanned), start taking 400 micrograms of folic acid daily. If you're in the high-risk category, consult your doctor about the higher dose (5000 micrograms).

This simple step can make a tremendous difference in your future child's health. Don't wait until you're pregnant - start today!

Medical Disclaimer

The information provided in this article is for educational purposes only and does not replace specialized medical consultation. Consult your doctor or nutritionist before starting any dietary supplement, especially if you're pregnant, planning pregnancy, or have special health conditions. The appropriate dose may vary according to your individual health condition.

For specialized nutritional consultations for pregnant women and those planning pregnancy, contact Dr. Mai Obeid via WhatsApp: +961 81 337 132