Folic acid and fertility: what is the right dosage

Folic acid keeps the body healthy and your immune system strong. It’s also vital for all sorts of biological functions, including the production of red blood cells that carry oxygen around your body. ¹

Folic acid is man-made. It usually comes in the form of a supplement or is added to certain foods like cereal. Adding vitamins and minerals to foods is known as food fortification and is more common in the US than in Europe.

The naturally-occurring version of folic acid is called folate. You can get it from all kinds of foods such as nuts, spinach and oranges. Generally speaking, you’ll be able to receive enough folate if you eat a diverse and balanced diet.

In certain circumstances, like pregnancies, your body needs more folic acid than usual. A large body of research has shown that the vitamin helps prevent neural tube birth defects (NTDs). These deformations may occur in the first weeks of pregnancy if the tube (the part that later develops in the brain and spine) fails to completely close. ² NTDs affect more than 4000 fetuses or babies in Europe each year. ³

But how much folic acid are moms-to-be supposed to consume? Let’s take a closer look.

Recommended dosages when you’re not working on a baby

An average adult needs around 300 micrograms (mcg) of folic acid or folate each day. ⁴ As mentioned, a healthy and wholesome diet with lots of green veggies will cover your needs. That’s the amount of two boiled asparagus (120g) and two pieces of Brussels sprouts (42g). But because the body doesn’t store folate long-term, you’ll need to eat folate-rich foods frequently. ⁵

German Nutrition Society broke down the recommended daily intakes of folate for different age groups:

⁠

Source: Deutsche Gesellschaft fur Ernharung

* Calculated as the sum of folate-effective compounds in normal food (folate equivalents) 1 mcg folate equivalent = 1 mcg dietary folate = 0.5 mcg supplemented folic acid

** Estimates

*** Women+ who are in their fertile years and/or are planning to become pregnant should take 400mcg of supplemented folic acid, in addition to a folate-rich diet

Folic acid during baby planning and pregnancy

It’s important to keep in mind that even if you regularly munch on that bowl of spinach and generally have a well-balanced diet, you may still not get enough folic acid to prevent birth defects.

That’s why introducing folic acid supplementation, in combination with consuming fortified foods (if they are available), is vitally important to ensure a healthy pregnancy.

Health experts recommend that all who are pregnant or are trying to conceive consume at least 400 mcg of folic acid as a supplement, once a day, for the first 12 weeks of pregnancy. ^6 7 8 910 Note that amount of the vitamin is in addition to eating foods rich in folate.

Folic acid supplements are recommended even if you’re not planning a baby but are in your reproductive age. Consider that many pregnancies aren’t planned and that neural tube defects start to form in the first six weeks after conception – which is typically before you get to see those two lines in the positive pregnancy test. ¹¹

In addition, if you take oral contraceptives you should pay special attention to your folate intake. Studies have shown that these types of birth control can deplete bodily reserves of important minerals and vitamins, including folic acid. If you stop taking the pill to become pregnant you are advised to first boost your folate stores before trying to conceive. ¹²¹³

Folic acid dosage if you’re more at risk for NTD

Some of you will need even higher doses of folic acid. If you’re pregnant with twins, for example, you should take 1000 mcg a day. ¹⁴

Being at higher risk of neural tube defects also means you need to consume much more than the “normally” suggested amounts. Experts will recommend taking between 4,000 and 5,000 mcg each day for three months before conceiving and all through the first three months of pregnancy. ¹⁵¹⁶ Higher risk usually means that you:

• have a family history of neural tube defects
• already had a baby with a neural tube defect
• are taking medicines against seizures (this medicine can interfere with the absorption of folic acid)

Make sure to first talk to your doctor or other health care provider before using more than generally recommended. They will be able to provide you with the folic acid version that is considered best for you.

Folic acid and breastfeeding

After giving birth, you may want to continue taking folic acid vitamins as you breastfeed the newborn. Folic acid has been linked to healthy brain development throughout childhood, so it is important that your baby receives the nutrient outside of the womb as well. How much should you take? The recommended dosage of folic acid during breastfeeding doesn’t change from the amount you should consume before and in the first 12 weeks of pregnancy. This means you should keep taking at least 400 mcg – in addition to the folate you received from food. ¹⁸¹⁹

(The values typically stay the same as during pregnancy – between 400 and 600 mcg.) ²⁰

What is the upper limit?

The level of folic acid you can consume without risking experiencing adverse effects is called “tolerable upper intake”. For folic acid, the upper value is at 1,000 micrograms per day. ²⁰ But, as talked about, higher doses are needed in some cases. With that, the tolerable upper intake also changes. If you’re in a higher risk group for neural tube defects, for example, you may get prescribed a larger dose, up to 5,000 mcg daily. ²¹

The recommended doses are there for a reason – taking too much folic acid can mask symptoms of a deficiency of another B vitamin – vitamin B₁₂. These symptoms of a run-down immune system and deficiency include tiredness and pale skin, and folic acid may correct that, but it won’t help with the nervous system damage because people are still deficient in vitamin B₁₂.

This effect was seen among some patients who were given very high daily dosages – more than 5,000 mcg of folic acid for many months. Vitamin B₁₂deficiency is mostly observed among people older than 65 years. ²²

That being said, folic acid is generally very safe to use. ²³ The vitamin is water-soluble which means that the excess folic acid will leave your body with urine.

What if you forget to take the supplement

Missing one or two doses most likely won’t cause any health problems. Just take the capsule as soon as you remember. If it’s nearly time for your next dose, skip the missed one and just take your next dose as normal. But don’t take two doses to make up for a forgotten one.

Where to get folic acid

Finally, here’s a brief rundown of your most readily accessible folic acid sources:

• Foods that naturally contain folate: There are many foods you can eat when trying to get pregnant that are rich in folate. Some popular suggestions include: broccoli, avocado, spinach, legumes and eggs.
• Supplements: one good place you can visit for supplemental folic acid is Donna’s shop. Our own QUTE PRENATAL capsules include all the prenatal vitamins and minerals you and your baby need before and during pregnancy, including active folic acid of the latest, fourth generation which means it’s highly absorbent. Interested in learning more about the benefits of an active form? We have an explainer article ready for that, too. 

REFERENCES

1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486472/
3. https://www.thelancet.com/journals/lancet/article/PIIS0140673607603092/fulltext
4. https://www.dge.de/wissenschaft/referenzwerte/folat/?L=0
5. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
6. https://www.who.int/selection_medicines/committees/expert/20/applications/Folic_acid.pdf
7. https://www.mayoclinic.org/drugs-supplements-folate/art-20364625
8. https://www.nhs.uk/medicines/folic-acid/
9. https://www.cdc.gov/ncbddd/folicacid/about.html
10. https://www.dge.de/wissenschaft/referenzwerte/folat/?L=0
11. https://www.glowm.com/section-view/heading/Fetal%20Neural%20Tube%20Defects:%20Diagnosis,%20Management,%20and%20Treatment/item/224#.Yh34NO7MKck
12. https://pubmed.ncbi.nlm.nih.gov/23852908/
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1862844/
14. https://www.uofmhealth.org/health-library/ue2418
15. https://www.nhs.uk/medicines/folic-acid/#pregnancy-and-breastfeeding
16. https://www.uofmhealth.org/health-library/ue2418
17. https://www.epilepsy.com/living-epilepsy/epilepsy-and/women/all-women/folic-acid
18. https://www.nhs.uk/medicines/folic-acid/#pregnancy-and-breastfeeding
19. https://www.bfr.bund.de/cm/350/folic_acid_intake_of_the_german_population.pdf
20. https://www.health.harvard.edu/womens-health/the-ups-and-downs-of-folic-acid-fortification
21. https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/
22. https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/folate-and-vitamin-b12-friendly-or-enemy-nutrients-for-the-elderly/D8C38CD6D49977957C5B098623459519
23. https://www.bfr.bund.de/en/frequently_asked_questions_about_folate_and_folic_acid-70348.html