How Much Folic Acid Before Pregnancy

Research Shows The Importance Of Timing When You Take Folic Acid During Pregnancy

The reason why you should take folic acid supplements before pregnancy is because it significantly reduces the risk of small for gestational age at birth. This is from a new study in BJOG: An International Journal of Obstetrics and Gynaecology.

Much Folic Acid During Pregnancy

This research study and systematic review of folic acid and pregnancy assessed the effect of timing of taking these supplements on gestational age at birth. The smaller your baby is at birth, the higher the chances of neonatal morbidity and mortality. If you dont take folic acid during pregnancy, your baby also has an increased risk of chronic diseases in later life, such as diabetes, hypertension, obesity, cardiovascular disease and mental health problems.

See why its so important to take folic acid during pregnancy and to be careful about how much folic acid to take when youre pregnant? The link to the full study on pregnancy and folic acid is below, in the Resources section.

These researchers found that while folic acid supplementation during pregnancy is a standard recommendation in North America and the UK, it isnt often done. They also conclude that more research needs to be done on folic acid and pregnancy, to determine how this mineral affects birth rate. They also want to study how much folic acid to take while pregnant for women who are at higher risk of giving birth to babies with low gestational birth weight.

Cant I Just Eat Lots Of Leafy Greens

Leafy greens, citrus fruits, and beans all contain natural folate, and all are nutritious options if youre pregnant. However, according to the CDC, its very difficult for people of childbearing age to get the daily recommended amount of folate through food alone. Thats why you need that extra 400 mcg of folic acid in pregnancy.

Fortified foods are also a good source of folate. In the late 1990s, the FDA began requiring food companies to add folic acid to flour and flour-based products. The CDC estimates that this change prevents neural tube defects in an average of 1,300 babies each year who would have otherwise been affected. But because fortified foods havent been enough to prevent all neural tube birth defects, the CDC recommends that anyone planning to get pregnant take a daily prenatal vitamin containing the necessary amount of folic acid for pregnancy.

Vitamin C In Pregnancy

Vitamin C protects cells and helps keep them healthy.

It’s found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.

Good sources include:

• soya drinks with added calcium
• bread and any foods made with fortified flour
• fish where you eat the bones, such as sardines and pilchards

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If You Have An Mthfr Variant Can Taking Folic Acid Help Prevent Ntds In Your Baby

Yes. If you have an MTHFR variant, taking 400 mcg of folic acid every day before and during early pregnancy can help prevent NTDS in your baby.

MTHFR stands for methylenetetrahydrofolate reductase. Its an enzyme that helps your body break down and use folate. One MTHFR variant is a change in your bodys MTHFR gene that makes you use folate more slowly than usual. Genes are parts of your bodys cells that store instructions for how your body grows and works. They are inherited . MTHFR variants are inherited. If you know you have an MTHFR variant or you think it runs in your family, talk to your provider.

Your provider may want to test you for an MTHFR variant if you have high levels of a substance in your blood called homocysteine. Too much homocysteine in your blood can cause heart conditions, blood clots and stroke. You can find out your homocysteine levels with a blood test. If your level is high, you can have a genetic test to see if you have an MTHFR variant. A genetic test looks for changes in genes that can cause birth defects or other medical conditions.

You may have heard not to take folic acid if you have an MTHFR variant because it can increase your risk of pregnancy complications and your baby having health problems. The Centers for Disease Control and Prevention recommends that all women take 400 mcg of folic acid every day before and during early pregnancy. If you have an MTHFR variant, talk to your provider.

What Happens If There Is Less Folic Acid In The Body

Less amount of folic acid in the body can lead to folate deficiency. The symptoms, though subtle, include:

• Irritability
• Headaches

In pregnant women, it can have adverse effects. A deficiency of folic acid can lead to low birth weight in babies, premature infants, and neural tube defects . The NTDs occurs when the neural tube fuses incorrectly during embryogenesis and causes defects. These include:

• Spina Bifida: Incomplete development of the spinal cord which leads to babies being permanently disabled.
• Anencephaly: Incorrect developments of the major parts of the brain which leads to disability and short lifespan of the baby.

Lesser folic acid is also related to pregnancy complications, pre-eclampsia, and miscarriage. It also increases the chances of heart disease, stroke, Alzheimers disease and certain types of cancers in women.

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How Much Folic Acid Do You Need

All pregnant women should take get at least 600 micrograms of folic acid daily, according to The American College of Obstetricians and Gynecologists. Most prenatal vitamins contain this amount of folic acid.

Taking folic acid after you discover youre pregnant may not be soon enough. Many women dont realize theyre pregnant until 6 weeks or more after conception. Neural tube defects occur during the first month of pregnancy, often before you realize youre pregnant.

To make sure you have enough folic acid in your body to prevent neural tube defects, the CDC recommends women who plan to become pregnant or who are of childbearing age take 400 mcg of folic acid daily.

If youve already given birth to a child with a neural tube defect, you may need higher doses of folic acid in the months leading up to your next pregnancy and during the first few months of pregnancy. Your doctor can advise you on the right dose.

You may also need higher doses of folic acid if you:

• have kidney disease and are on dialysis
• have liver disease
• drink more than one alcoholic beverage daily

Natural folate is found in many foods including leafy greens, beets, and broccoli. Some foods in the United States are fortified with folic acid. These include:

• cereals
• orange juice
• pasta

Theres no guarantee that you will get enough folic acid from food alone, so a supplement is important.

Where Does Folic Acid Occur Naturally In Food

There are natural sources of folic acid in food, including:

• Wholemeal bread
• Tinned salmon
• Brussels Sprouts.

Although it is important to eat a healthy, balanced diet, including these foods, before and during pregnancy, it would be incredibly difficult to eat enough to get the right amount of folic acid purely from food. This is why it is so important to take supplements if you’re thinking about getting pregnant.

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How Long After Taking Folic Acid Will I Get Pregnant

Everybody is different when it comes to fertility and the likelihood of conceiving. Folic acid supplements are not guaranteed to help you get pregnant but are an essential nutrient that every woman should take when planning to get pregnant. So kick off your day with a green smoothie, freshly squeezed orange juice, or a handful of almonds. Youll be glad you did!

• Foods like leafy green vegetables including spinach, kale, and arugula are rich in folic acid.
• Legumes, which include beans, peas, and lentils, are another great source of folic acid.
• Folic acid can also be found in citrus juices, asparagus, beets, and nuts.

Folic Acid Vs Methlyfolate

Folic acid is the synthetic form of folatefound in most leading prenatal vitamin brands. Your body must convert folic acid into methylfolate. Unfortunately, some women may not fully absorb folic acid. Methylfolate is a science-y term for the active form of folate that all women can fully absorballowing this vital nutrient to support their babies. Thats why advanced prenatal vitamins with methylfolate are so important they help mom successfully provide this crucial nutrient to their developing babies.

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Ive Been Trying To Get Pregnant But Havent Been Taking Folic Acid Supplements Should I Stop Trying To Conceive

Ideally, you should take folic acid supplements for two to three months before you conceive and until you are 12 weeks pregnant.

But try not to worry if you havent started taking the supplements yet and start taking it now. You can talk to your GP or midwife if you have any concerns.

1. Sue Macdonald, Gail Johnson, Mayes Midwifery. , p 312.

2. NHS Choices Why do I need folic acid in pregnancy? Page last reviewed: 16/03/2016 Next review due: 16/03/2018

3. NHS Choices Spina bifida Page last reviewed: 04/05/2017 Next review due: 04/05/2020 www.nhs.uk/conditions/spina-bifida

4. NHS Choices Vitamins and minerals Page last reviewed: 03/03/2017 Next review due: 03/03/2020

Review dates

Last reviewed:Next review:

Find out more about planning a pregnancy

• Taking a pregnancy test

  Pregnancy tests work by looking for a hormone called human chorionic gonadotrophin . This hormone is only made in your body when you are pregnant.

Folic Acid And Male Fertility

The need for folic acid or folate in women of childbearing age is well-known. But could folic acid improve male fertility? Before we get an embryo, we need an egg and a sperm.

While women are born with all the eggs they will ever have, the man’s body creates sperm on a daily basis. In fact, 1,500 new sperm cells are “born” every second.

The process from germline stem cell to sperm cell takes about 60 days. Folate is an essential nutrient when it comes to cell division and DNA synthesis

Folate levels measured in semen have been associated with sperm count and health. One study found that low folate levels in semen were associated with poor sperm DNA stability. From this, we may learn that folate plays an important role in sperm health.

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How To Get Enough Folic Acid To Prevent Neural Tube Defects

In addition to eating foods with folate from a varied diet, women can get folic acid from

• Taking a vitamin that has folic acid in it:
• Most vitamins sold in the United States have the recommended daily amount of folic acid that women need for the prevention of neural tube defects. Vitamins can be found at most local pharmacy, grocery, or discount stores.

If taking folic acid for reasons other than neural tube defect prevention, talk to your healthcare provider.

Taking Folic Acid When Youre Trying To Get Pregnant

Women who are trying to get pregnant or who are capable of becoming pregnant should take 0.4 mg of folic acid per day. The effects of higher dosages of folic acid are not well known, but could complicate the diagnosis of a vitamin B12 deficiency. To learn more about the B12 vitamin and pregnancy, read How Vitamin B12 Affects Fertility.

So, women who are not pregnant yet should be careful NOT to take more than 1 mg per day of folic acid except under supervision of a doctor or ob-gyn. If you have had a baby in the past who had a neural tube defect, then your next baby is at a higher risk of future health problems.

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Why Do I Need To Start Taking Folic Acid Before I Get Pregnant

According to the CDC, getting the daily recommended amount of folic acid into your system a month before the start of your first trimester can reduce the risk for neural tube defects by 50 to 70 percent. This timing of when you take folic acid in pregnancy is crucial because neural tube formation occurs very early. Most women do not know they are pregnant until after neural tube formation has occurred.

How Much Folic Acid Should I Be Taking

It is not only the amount of folic acid that you take that is important, but the timing. Most neural tube defects happen in the first 4 weeks of pregnancy, often before the mother is even aware she is pregnant. Roughly half of pregnancies are unplanned, so even if you are not trying to get pregnant but are of reproductive age, consider taking a daily multivitamin containing 0.4 mg folic acid. If you are trying to conceive, folic acid supplementation differs depending on your particular risk for neural tube defects. In addition to eating a diet rich in folic acid, follow the recommendations in this table.

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How Folate Helps Prevent Neural Tube Defects

Neural tube defects Footnote 6 include spina bifida and anencephaly. They occur when the neural tube fails to close properly during the third and fourth week of pregnancy. Often a woman doesn’t yet know that she is pregnant during this critical time. A decreased risk of NTD is associated with both increased folate intake and higher red blood cell folate concentrations though the experimental evidence is stronger for increased folate intake and NTD risk reduction .

The risk is reduced when women start taking a daily multivitamin containing folic acid three months before the beginning of pregnancy and continuing in early pregnancy while the neural tube is closing Footnote 7 . The reduced risk has been observed in women who took a supplement containing 360 to 800 mcg of folic acid per day, in addition to an intake of 200 to 300 mcg per day of natural folate .

Many studies also show that multivitamins containing folic acid taken in the early weeks of pregnancy are associated with a decreased risk of oral cleft and cardiovascular anomalies . Some evidence also suggests an association with reduced risk of preeclampsia . This is an area of active and on-going research.

Mixing Folic Acid With Herbal Remedies Or Supplements

Talk to your pharmacist or doctor before taking any herbal remedies or supplements together with folic acid.

Some vitamin and mineral supplements may already contain folic acid.

Tell your pharmacist or doctor if you take any supplements or remedies that contain zinc.

Folic acid can stop zinc working as well as it should.

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How Much Ferrous Iron To Take During Pregnancy

Danish researchers wanted to determine what the lowest dose of folic acid would be, to prevent iron deficiency and anemia in women who are pregnant. They found that a supplement of 40 mg ferrous iron/day from 18 weeks of gestation appears adequate to prevent folic acid or iron deficiency in 90% of the women. Further, this dosage of folic acid during pregnancy prevented iron deficiency anemia in at least 95% of the women after they had their babies .

To learn more about being pregnant, read 10 Tips for a Healthy Pregnancy From a Nurse Midwife.

I welcome your thoughts on folic acid and pregnancy below, but I cant offer medical or health advice. Talk to your ob-gyn or family doctor if you arent sure about how much folic acid to take during pregnancy.

Sources: 1) VA Hodgetts, RK Morris, A Francis, J Gardosi, KM Ismail. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 2014 2) Milman, N., Bergholt, T., Eriksen, L., Byg, K. E., Graudal, N., Pedersen, P., & Hertz, J. . Iron prophylaxis during pregnancyhow much iron is needed? A randomized doseresponse study of 2080 mg ferrous iron daily in pregnant women. Acta obstetricia et gynecologica Scandinavica, 84, 238-247. and 3) Prenatal Nutrition Guidelines for Health Professionals Folate Contributes to a Healthy Pregnancy via Health Canada.

Where To Get Pregnancy Supplements

You can get supplements from pharmacies and supermarkets, or a GP may be able to prescribe them for you.

If you want to get your folic acid from a multivitamin tablet, make sure the tablet does not contain vitamin A .

You may be able to get free vitamins if you qualify for the Healthy Start scheme.

Find out more about the Healthy Start scheme.

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