Pregnancy and folic acid

What is folic acid?

Folic acid (folate) is a vitamin and is needed to make new cells in the body. The body does not store very much folic acid. You need a regular fresh supply to keep healthy. Pregnant women in particular need a good supply of folic acid which is used by the developing baby. The very early stages of pregnancy are crucial in the need for folic acid. This is why folic acid supplements are recommended for women planning a pregnancy.

Many foods contain folic acid including vegetables such as spinach, sprouts, broccoli, green beans, and potatoes. Some bread and breakfast cereals are fortified with folic acid. However, the intake for each individual can vary.

Folic acid supplements and pregnancy

If you take folic acid tablets (supplements) in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida. This is because the early development of the baby's spinal cord requires a regular, good supply of folic acid. There is also evidence that folic acid also reduces the risk of having a baby born with a cleft lip and palate, a heart defect (congenital heart disease), and the risk of a premature (preterm or early) labour.

Ideally, start taking folic acid tablets before becoming pregnant. The common advice is to start from the time you plan to become pregnant. If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant.

However, a recent study looked at the effect of taking folic acid for a year prior to becoming pregnant. This study looked at the effect folic acid had on reducing preterm labour and delivery of the baby (that is, of having a 'prem' baby). The study found a significant decrease in the rate of preterm delivery for women who took folic acid for one year prior to becoming pregnant. So, you may wish to consider taking folic acid tablets well before you plan to become pregnant.

Continue to take folic acid tablets for the first 12 weeks of pregnancy.
What dose should I take?

• For most women the dose is 400 micrograms (0.4 mg) a day.
• If your risk of having a child with a spinal cord problem is increased then the dose is higher (5 mg a day - you need a prescription for this higher dose). That is, if:

o you have had a previously affected pregnancy
o you or your partner have a spinal cord defect
o you are taking medication for epilepsy
o you have coeliac disease, diabetes, sickle cell anaemia, or thalassaemia.

In addition to folic acid supplements, you should eat a healthy diet when you are pregnant which should include foods rich in folic acid.

Where do I get folic acid supplements from?

You can buy folic acid tablets from pharmacies. They are also available on prescription. Also, the NHS Healthy Start scheme provides vitamin supplements that contain folic acid. These are free to many women who are on certain benefits - see: www.healthystart.nhs.uk

Because of the substantial benefits of folic acid, some countries routinely fortify staple foods such as wheat, corn flour, or rice with folic acid. Currently there is debate as to whether the UK should follow suit and fortify certain common foods with folic acid. (See the references at the end for details of this debate.)

Are there any side-effects or risks when taking folic acid?

No. Folic acid is a naturally occurring vitamin which your body needs. It is not a drug (medicine). By taking these supplements you are just making sure that you get a good, regular amount of folic acid which you need especially during pregnancy.

Further information

Information from the Department of Health

Web: www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/Maternalnutrition/index.htm

References

• Antenatal care, NICE Clinical Guideline (March 2008)
• Pre-conception - advice and management, Clinical Knowledge Summaries (2007)
• Folic Acid May Help Prevent Premature Birth - A report on proceedings from Society of Maternal-Fetal Medicine annual meeting 2008
• Bille C, Murray JC, Olsen SF; Folic acid and birth malformations. BMJ. 2007 Mar
• Ionescu-Ittu R, Marelli AJ, Mackie AS, et al; Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ. 2009 May
• Gardiner HM, Fouron JC; Folic acid fortification and congenital heart disease. BMJ. 2009 May 12
• Wald NJ, Oakley GP; Should folic acid fortification be mandatory? Yes. BMJ. 2007 Jun 16
• Hubner RA, Houlston RD, Muir KR; Should folic acid fortification be mandatory? No. BMJ. 2007 Jun 16

Updated: 7th May 2009