Folic Acid - Why it is an important supplement to take when trying to conceive and during pregnancy

Should you take Folic Acid? When you’re trying to conceive knowing just which supplements you should be taking can be difficult. There are so many you could take, but many of these don’t have the evidence base behind them, and it’s so important to take the right supplements for you. However there is a supplement to take that is crucial and has all the evidence to support it’s use and this is folic acid. This blog was written by Nitin Makadia (BSc MRPhamS) who is the Medical Writer for the lovely people at Dr Fertility and first published on their blog.

Why is folic acid important in pregnancy and when trying to conceive?

Whether you are thinking about your journey to start a family or have been trying to conceive for some time, an important nutrient you might have come across is folic acid. The NHS recommends that, alongside a balanced diet and healthy lifestyle, all women should take a daily 400 microgram folic acid supplement while trying to conceive and throughout the first 12 weeks of pregnancy to increase maternal folate status. This is important because a low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus. Neural tube defects are birth defects affecting the brain or spinal cord.1 If you have a family history of neural tube defects, epilepsy or suffer from obesity, you should consult your doctor.

Despite this, researchers found that, amongst nearly 500,000 women who were questioned, fewer than one in three took folic acid before becoming pregnant.2

What is folic acid and why is it important?

Folic acid, also known as vitamin B9, is found in foods such as leafy green vegetables, brown rice, granary bread and also in cereals which are fortified with folic acid.1  The Government has also considered fortifying flour with folic acid because it is so important.3  At this point it would be useful to mention that you may see folic acid also being called folate. Folate is another form of folic acid that is naturally found in food, whereas folic acid is the man-made form found in most supplements. Your body converts folic acid into a type of folate before it can be used. For now, it’s easier to think about them as being the same thing.

Folic acid has a number of important roles in the body, such as helping your blood to form normally.4 But our key focus is on its role in the early part of pregnancy. Folic acid contributes to maternal tissue growth during pregnancy and combats low maternal folate status which is a risk factor in the development of neural tube defects. In the UK, around 1000 pregnancies are affected by neural tube defects each year.3

When and how much folic acid should you take?

Your body has an increased need for folate during pregnancy, but it takes time to increase your maternal folate status. Most women planning a pregnancy should take a daily supplement containing 400 micrograms of folic acid on top of what they should already be getting from a healthy balanced diet.

Additional supplementation with folic acid should be taken daily at least 1-month before you conceive and for 12 weeks after conception. Folic acid is a water soluble vitamin that is not stored in large amounts in your body8, so it is generally advised that, as soon as you are planning to start a family, you should begin taking a folic acid supplement so that your body is prepared for when you do conceive. You should then carry on taking it for at least 12 weeks into your pregnancy1 to increase your maternal folate status for those crucial first few weeks when your baby’s brain and spinal cord are developing. 

Some women may have a higher risk of their pregnancy being affected by a neural tube defect. This might be if you or your partner have any history of neural tube defects in your family, or in previous pregnancies.1 There is also an increased risk if you have diabetes, are taking anti-epilepsy medicines or in women who are obese with a body mass index (BMI) of over 30.6 If this is the case, please consult your doctor. If you have any medical conditions or allergies, it’s always best to check with your doctor before starting to take a folic acid supplement just in case it’s not suitable for you.4

What if you haven’t been taking folic acid before you become pregnant?

Firstly, don’t panic! If you are already taking a supplement designed specifically for fertility or for pregnancy, just check the ingredients. The chances are it may already contain the recommended 400 micrograms of folic acid, or folate, per daily dose. Not all supplements do, so it’s best to check and, if it doesn’t already contain folic acid or folate, then start taking your supplementary daily folic acid as soon as you can. Just check with your doctor first if you fall into one of the higher risk categories, as mentioned above. If you are taking a supplement that is not designed specifically for fertility, just check that it does not contain vitamin A (retinol). Vitamin A is still important to take in low levels through a healthy balanced diet but, during pregnancy, vitamin A supplements or foods that are naturally high in vitamin A, such as liver, should be avoided. Pregnancy and fertility supplements will often instead contain beta-carotene, which your body can convert to vitamin A only when it is needed.9  

If you are now more than 12 weeks pregnant and have not been taking a folic acid supplement, it’s important to know that the chances of your baby developing a neural tube defect are still very small. For example, spina bifida is found in only 6 out of every 10,000 babies.5 Talk to your doctor or midwife about any concerns you have so that they can keep a close watch on your baby’s health as part of your routine antenatal care.

So, the takeaway messages are, as long as there are no other health concerns:

  • Eat a healthy, nutritionally balanced diet every day which is rich in folic acid containing foods, such as green leafy vegetables, brown rice, granary bread and cereals which are fortified with folic acid
  • Make sure you are taking 400 micrograms of folic acid daily, as recommended by the NHS, either on its own or contained within another fertility supplement. Start your folic acid supplement as soon as you decide you want to start trying for a baby and continue to take it until 12 weeks after conception
  • If you fall into one of the higher risk categories such as a family history of neural tube defects, previous pregnancy with neural tube defects, a BMI over 30, diabetes or you take anti-epilepsy medicines, consult your doctor
  • If you take a multivitamin supplement, do make sure it doesn’t contain vitamin A (also known as retinol), which can be harmful in pregnancy if you take too much.7
  • Get into a routine of taking your folic acid every day, perhaps in the morning with breakfast, so that you don’t forget.

REFERENCES

  1. Why do I need folic acid in pregnancy? [Online content accessed 14.04.20]

https://www.nhs.uk/common-health-questions/pregnancy/why-do-i-need-folic-acid-in-pregnancy/

  • Bestwick JP, Huttly WJ, Morris JK, Wald NJ. Prevention of neural tube defects: a cross-sectional study of the uptake of folic acid supplementation in nearly half a million women. PLoS One. 2014;9(2):e89354. doi: 10.1371/journal.pone.0089354

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929694/

  • Proposal to add folic acid to flour: consultation document [Online content accessed 15.04.20]

https://www.gov.uk/government/consultations/adding-folic-acid-to-flour/proposal-to-add-folic-acid-to-flour-consultation-document

  • NHS UK: Folic acid [Online content accessed 14.04.20]

https://www.nhs.uk/medicines/folic-acid/

  • PHE Screening: New spina bifida and anencephaly information leaflets for parents published [Online content accessed 15.04.20] 
  • NHS UK: Conditions/Spinda bifida [Online content accessed 16.04.20}

https://www.nhs.uk/conditions/spina-bifida/causes/

  • NHS UK: Vitamins, supplements and nutrition in pregnancy [Online content accessed 16.04.20]

https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-minerals-supplements-pregnant/

  • MedlinePlus – Folate deficiency [Online content accessed 07.08.20]

https://medlineplus.gov/ency/article/000354.htm

  • HSIS – Betacarotene [Online content accessed 07.08.20]

https://www.hsis.org/a-z-food-supplements/

Last updated on: 21/08/2020   Review by: 21/08/2023