If you're pregnant or you’re trying to get pregnant, it's critical that you get enough folic acid. And, unless you like eating large platefuls of raw spinach for breakfast, lunch and dinner, it’s best taken via supplements.
Folic acid is the man-made form of folate (see What is Folate? below), which is important in cell growth and reproduction, and helps to reduce the risk of your baby having a neural tube defect.
“The best thing you can do for your baby is ensure your diet is on-track and full of goodness before you get pregnant, which includes eating folate-rich foods and taking a folic acid supplement,” says OHbaby! nutritionist Anna Hansen.
Why we need folic acid
It helps reduce the risk of neural tube defect (first occurrence) when the right amount is taken taken at least one month before conception and for 12 weeks after conceiving.
What is a neural tube defect (NTD)?
Neural tube defects (NTDs) are a major group of birth defects where the brain, spinal cord, or the covering of these organs don’t develop properly. Spina bifida and anencephaly are the most common types of NTDs. Spina bifida results from the failure of the spine to close properly during the first month of pregnancy. Children with spina bifida can have varying degrees of paralysis of their lower limbs – some children can be confined to a wheelchair, whereas others have almost no symptoms at all. The condition can also cause bowel and bladder problems. Babies born with anencephaly have underdeveloped brains and incomplete skulls. Most infants born with anencephaly do not survive more than a few hours after birth.
What happens if I have too much folic acid?
Consuming excessive folic acid could be harmful, and some studies have shown that it could mask a vitamin B-12 deficiency. However, Anna believes more studies need to be carried out to determine the actual risks.
So, how much folic acid do I need?
Women at low risk of a NTD affected pregnancy and who plan to become pregnant, are recommended to take a 800 µg of folic acid daily for at least four weeks prior to conception and for 14 weeks after conceiving to reduce the risk of NTDs.
Women who are themselves affected with a NTD, or who have had a child with a NTD, or a close family member who has had a NTD, or whose partner is affected or had a family history of NTD, are recommended to take a higher dose of 5000 µg (5 mg) of folic acid daily with subsequent pregnancies for at least four weeks prior to conception and for 12 weeks after conceiving to reduce the risk of NTDs.
A daily folic acid tablet of 5 mg is also recommended for women who are on insulin treatment for diabetes for at least four weeks prior to conception and for 12 weeks after conception to reduce the risk of NTDs.
A daily folic acid tablet of 5 mg is also recommended for women who are taking medications known to affect folate metabolism such as anti-convulsants, infertility treatment, vitamin A analogues used to treat acne and some anti-tumor agents; for example, carbemazepine, clomiphene, valproate, retinoids and etretinate. This tablet should be taken for at least four weeks prior to conception and for 12 weeks after conception to reduce the risk of NTDs.
What is folate?
Folate is an essential B vitamin found naturally in leafy green vegetables, citrus fruits, wholemeal bread, yeast, liver and legumes, but it’s not as easily absorbed as a folic acid supplement. For example, you’d have to eat the equivalent of 500g of raw spinach, or 900g of boiled spinach or raw broccoli daily to get the amount needed to reduce the risk of having a baby with a neural tube defect.
Some cereals and cereal products, bread, and fruit juice actually have folic acid voluntarily added to them by food manufacturers.
Why we need folate
If you’re folate deficient, you could get a type of anaemia called ‘megaloblastic anaemia’, a blood disorder characterised by the presence of enlarged immature and dysfunctional red blood cells (megablasts).
How much folate do I need?
The Ministry of Health recommends you take an 800ug folic acid tablet at least one month before you start trying to conceive, and then through the first 14 weeks of pregnancy. Please note: if there is a higher risk of an NTD-affected pregnancy it is recommended you take a higher dose.
New Zealand adults should take around 400 micrograms (µg) of folate each day, but if you’re pregnant you need around 600 of folate µg daily, and if you’re breastfeeding, around 500 µg of folate daily.
*1999 Berry et al