Everything you need to know about folic acid in pregnancy: benefits, uses, doses and side effects

  • PUBLISHED November 02, 2023
  • AUTHOR Donna

Key takeaways

  • Folic acid is a synthetic form of vitamin B9 which is vital for growth as well as for keeping your immune system strong.
  • The nutrient plays an especially important role in pregnancy. It helps prevent certain defects that occur when the neural tube doesn’t close properly.
  • Doctors recommended that women+ take at least 400 micrograms (mcg) of folic acid daily for three months before conception all the way through the first semester of pregnancy.
  • Folic acid is generally safe, but it is still recommended you don’t consume more than 1,000 mcg per day. A higher dose may, in some cases, mask symptoms of a B12 deficiency.

Everything you need to know about folic acid in pregnancy: benefits, uses, doses and side effects

When you’re pregnant, your body is capable of amazing achievements but it needs some extra fuel to do so. One of the essential nutrients that you’ll need to load up on during pregnancy is folic acid. It’s a man-made form of folate, which is also known as vitamin B9.

Folic acid is an all-around superstar nutrient. It’s essential for the growth and healthy development of our bodies. It contributes to normal blood formation, participates in cell division, supports a strong immune system and reduces tiredness. 1 2

What are the benefits of folic acid in pregnancy, how much you should take and are there any side effects? We explain everything you need to know and more.

Folate and folic acid: what’s the difference?

Folate and folic acid are often used interchangeably but they are not the same. Folate, for one, is found naturally in all kinds of foods. Good sources of folate are: 3

  • broccoli, brussels sprouts, cabbage, cauliflower,
  • spinach, green beans, lettuce, mushrooms, zucchini
  • avocado, grapefruit, orange
  • chickpeas, soya beans, red kidney beans, lentils
  • eggs
  • nuts
  • orange juices
  • banana
  • liver
  • asparagus
  • granary bread
  • brown rice

Skipping your folate diet may lead to folate-deficiency anemia – a condition where the body can’t produce enough red blood cells to carry oxygen throughout the body. 4 Some of the most common symptoms include pale skin, lack of energy, tiredness or reduced sense of taste. 5

Folate has its downsides; the main one is its instability. It’s water-soluble which means that high temperatures (cooking, for example) destroy much of the folate nourishing powers. If during pregnancy, for example, you would have to eat a lot of boiled spinach to get the amount of folate that’s needed to reduce the risk of having a baby with a neural tube defect. Folic acid, on the other hand, is more readily absorbed and stable than folate, while providing the same benefits. 6

There are two main ways how you can get folic acid: with supplements, such as our QUTE PRENATAL, or from certain foods where folic acid is artificially added. Rice, pasta, bread, and some breakfast cereals are sometimes fortified with precious vitamin. Food fortification, however, is more common in North America where it is mandatory which is not the case in Europe.

What are neural tube defects in pregnancies

Folic acid plays an important role in early pregnancy. 7 It supports neural tube development, a part of the embryo that eventually evolves into the baby’s brain, spinal cord and skull. The tube is completely formed 21 to 28 days after conception. 8 910

Things can go wrong if the neural tube fails to properly close in the womb, leaving the developing brain or spinal cord exposed to the amniotic fluid (the liquid that protects the growing fetus). This gap in the spine is also called an open neural tube defect (NTD). The two most common types of NTD are anencephaly and spina bifida – in the first case, it’s the upper part of the neural tube that fails to close, in the second case it’s the lower part.

Neural tube defects affect around 300,000 babies worldwide each year. 11 While most babies born with spina bifida survive, they may have to live with a number of disabilities, including loss of bladder control or leg paralysis. Anencephaly, on the other hand, is fatal.

The power of folic acid

An abundance of research shows that folic acid can help prevent between 50 to 70 percent of neural tube defect. 121314 Doctors and health organizations around the world encourage people who menstruate to add folic to their diet – not only during first weeks of pregnancy but already in the baby-making period. 1516

The general rule is to start taking folic acid three months before conception. The moment you become pregnant (and before you become aware of the fact) the embryo already reproduces important cells that are vital for brain and spine development. Waiting for those two lines on the pregnancy test to show up could mean you’ve missed the window for maximizing folic acid benefits.

Many pregnancies also aren’t planned – a good general recommendation is to take a minimum recommended amount of folic acid each day. 17

The dosage: how much of folic acid should you take

Generally speaking, experts recommend that a pregnant person receive at least 400 mcg (micrograms) of folic acid per day – in addition to the folate received from food. 1819

Keep in mind that there are exceptions where higher doses are needed. If you’re in a higher risk group for neural tube defects, a doctor may prescribe a larger dose of folic acid. We are usually talking about 4,000 micrograms of folic acid daily one month before becoming pregnant and through the first three months of pregnancy. 20

There are a couple of factors that could indicate you may have a higher chance of NTD. 21

  • you or the baby’s father have a neural tube defect
  • family history of neural tube defects
  • previous pregnancy affected by a neural tube defect
  • diabetes
  • taking anti-retroviral medicine for HIV
  • taking anti-epileptic medication

MTHFR gene and folic acid conversion into an active role

Folic acid supplements are available without a prescription. Check Donna’s QUTE follic acid supplement that includes just the right amount of folic acid you’ll need for a healthy pregnancy. The folic acid is of the latest, fourth generation which is highly soluble, stable and metabolically active. 22

In comparison, the food folate and folic acid of the second generation are not biologically active. This means they need to be first converted into the metabolically active L-methylfolate form that the body can use. The MTHFR gene plays a key role in the process – it provides the instructions for making the key enzyme methylenetetrahydrofolate reductase which then facilitates the conversion into an active form. 232425

A significant portion of the world’s population (around 55 percent of Europeans), however, has a genetic mutation (polymorphism) that limits their bodies from converting from folic acid into an active, usable form. 26 It’s therefore important to use folic acid supplements that are already in reduced and active form, effectively bypassing that genetic variation. 27

Once you have your folic acid ready, you can take it anytime you want during the day. We still suggest you develop a habit. Taking the vitamin with breakfast, for example, is a simple trick not to forget your daily dose.

Can you overdose on folic acid?

Folic acid is not a nutrient that would cause a lot of complications. If you take too much of it, the excess will simply leave your body as urine. For a majority of people, there is little risk that comes with taking (too much) folic acid.

The “maximum safe amount” of folic acid is still limited at 1,000 mcg per day. 2829 And there is a good reason for caution: too much folic acid may mask symptoms of a vitamin B12 deficiency, such as tiredness and pale skin. But that doesn’t mean you stop being deficient in vitamin B12. Long-term, this can lead to serious and irreversible damages for the nervous system. 30 Vitamin B12 deficiency is mostly observed among people older than 65 years. 31

Once in your bloodstream, the liver breaks down and converts folic acid into other forms. The organ, however, has its limits and is only able to process a certain amount of folic acid at a time. Most folic acid will leave the body with urine but consuming more than the recommended 1000 mcg per day may cause some unmetabolized folic acid (UMFA) to accumulate in your blood. At the moment, research is not conclusive whether this unmetabolized folic acid causes any adverse side effects, although some suggest it could affect immune support.32333435

On the other hand, you can’t overdose on folate as it’s simply not possible to consume that much food. So – kick off your day with a kale smoothie, possibly along with folic acid supplement, and you’ll be all set!

Other benefits of folic acid in pregnancy

Folic acid may support healthy pregnancy beyond birth defect prevention. One study from 2016, for instance, suggests that the nutrient might lower the risk of having a child who is obese. 36 Other research theorizes that folic acid may reduce the risk of pregnancy complications such as preterm labor, problems with the development of the placenta, and other birth abnormalities, such as heart disease. Folic acid could also help prevent mouth defect in which the lip has an opening in it and doesn’t form correctly. 37

Moreover, some studies have found associations between the folic acid and reduced occurrence at birth of urinary tract anomalies, oral facial clefts and limb defects. 38 Keep in mind, however, that the results of these studies are not as established as with neural defect prevention.

Folic acid and fertility

Although the research is far from conclusive, there is some indication that folic acid may improve the chances of getting and staying pregnant. 39 The theory is based on a suggestion that people who menstruate take multivitamins with folic acid are more likely to ovulate. Read more on the folic acid and fertility in our article here.

Risks of taking folic acid

Generally speaking, folic acid, taken at recommended doses, is considered safe. 404142 Some people, however, may experience minor side effects such as:

  • Bad taste in the mouth
  • Nausea
  • Loss of appetite
  • Confusion
  • Irritability
  • Sleep pattern disturbance

Signs of an allergic reaction to folic acid include skin rash, itching or redness. Read our article to learn more about possible side effects.

Folic acid and interactions with other drugs

According to Mayo Clinic, one of the top-rated US hospitals committed to education and research, folic acid could decrease the effectiveness of certain drugs if taken together: 4344

  • Anticonvulsants (antiepileptic drugs)
  • Barbiturates (central nervous system depressant)
  • Methotrexate (used to treat cancer could interfere with its effectiveness.
  • Pyrimethamine (antimalarial drug)

One possible way how to lower the possibilities of interaction is to separate drug and folic acid doses by two to four hours. And talk to your doctor first if you plan to take these substances together.

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