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Getting Pregnant

Folic Acid: When Should I Start Taking It? 

 If you’re trying to conceive, you’ve probably already heard people talking about folate (or the synthetic version, folic acid) as one of the essential prenatal vitamins. But when should you start taking it? 

Knowing when to take folic acid, and in what quantity, can help prevent serious birth defects. However, some controversy surrounding folate and folic acid exists. In the interest of providing the best information available, we’ll also address those concerns. 

 

Key Takeaways: 

  • Folate and folic acid are two different forms of vitamin B9, which help cell growth 
  • Folate occurs naturally in food, while folic acid is the synthetic version found in vitamins or processed foods 
  • Folate and folic acid are instrumental in preventing neural tube defects  
  • You should start taking folate supplements at least a month prior to conception (because these defects develop very early on—before you know you are pregnant) 
  • There is some evidence that taking too much folate can be detrimental to your health 

 

What is folic acid? Is it different from folate?

 

Folic acid is a synthetic B-vitamin found in vitamin supplements. When naturally occurring in food (such as leafy green vegetables, beans, and some fruits) this vitamin is called folate. Folate is vital for copying and synthesizing DNA, supporting nerve and immune function, and creating new cells.  

 

What does folic acid do?

 

Taking folic acid or folate can help prevent defects of your baby’s spinal cord and brain.  About 1 – 2 in every 1000 pregnancies are affected by neural tube defects and are either terminated following prenatal screening and diagnosis, or result in the birth of individuals with fatal or severely disabling malformations. 

 

When should I start taking it?

 

Ideally, you should begin taking folic acid before you start trying to conceive. The Centers for Disease Control (CDC) recommend that a woman trying to conceive begins a folate supplement at least a month prior to conception. This is because folate plays an incredibly important role during early development. In fact, sufficient folate is most beneficial in the first 28 days after conception—which often overlaps with the period during which a woman doesn’t yet know she’s pregnant. 

 

How much should I take?

 

Because almost 50% of pregnancies are unplanned, the CDC recommends that all women between 15 and 45 capable of bearing children should supplement even a folate-rich diet with 400 micrograms of folic acid each day, in addition to consuming food with folate from a healthy and varied diet. 

 

Some women may need a higher daily supplement. Talk to your doctor if you: 

  • Have carried a previous infant (liveborn or stillborn) with a neural tube defect 
  • Did not plan your pregnancy and were not taking supplements when it began 
  • Are taking medications (many medications act as folic acid antagonists, resulting in higher rates of pregnancy complications) 
  • Have had gastric bypass surgery 
  • Have a condition such as diabetes, epilepsy, inflammatory bowel disease, obesity, or liver disease 
  • Have a history of alcohol overuse or smoking 
  • Know neural tube defects have occurred in your family (such as siblings, parents, and cousins)
     

So, what’s the controversy?

While virtually everyone agrees that folate is important, there is a controversy surrounding the synthesized version of folate. This controversy primarily relates to the difference between how dietary folate and synthetic folic acid break down in the body. Your genetics can determine how quickly your body is able to break down folic acid. 

Cells in the intestines easily transform dietary folate into a form of folate called 5-methyltetrahydrofolate (5-MTHF). 5-MTHF is vital for cell creation and function. Folic acid can also be transformed into 5-MTHF, but it is a two-step process requiring two different liver enzymes. Unfortunately, these enzymes can be overwhelmed by the amount of folic acid you’re ingesting, slowing down the rate of transformation and leading to unmetabolized folic acid. Unmetabolized folic acid has been linked to cancer, vascular diseases, psychiatric disorders, and the very neural tube defects we take folic acid to prevent.  

However, a recent study found that there is no reason to set an upper limit on the amount of folic acid taken. This study claims that the earlier idea of a higher dose of folic acid being neurotoxic was based on a flawed analysis. (Basically, the study found that neurological damage originally attributed to an excess of folic acid wasn’t actually caused by folic acid.) 

 So, again: it’s a controversy as there are still differing opinions on this. (For a much more detailed analysis of folate versus folic acid, including the genetics that could be relevant to you, check out our post, Folate Versus Folic Acid: How to Decide Which One is Better for You.)
  

Which foods contain folic acid?

Folic acid can be found in foods such as: 

  • Meats (especially liver) 
  • Peanuts 
  • Dried beans and legumes (kidney beans and lentils) 
  • Some whole grains (like enriched flour, rice, or cornmeal) 
  • Fortified breakfast cereals 
  • Citrus fruits (especially oranges and orange juice)
  • Dark green, leafy vegetables (such as spinach and broccoli) 

 

In the United States, it has been mandatory to fortify enriched grain products with folic acid since 1998. 

Is getting it through my food enough?

 

Although eating folate-rich foods can certainly help, obtaining enough folate from diet alone is difficult. One reason for this is the instability of the vitamin compound, which may be reduced up to 70% during the milling or baking.  

Given the importance of folate and folic acid, most physicians recommend taking a supplement to ensure the daily recommended dose is reached. (If you need more folic acid information, see our article on choosing the best prenatal vitamins.) 

 

What are the risks of not taking folic acid or folate?

 

Adequate folate helps prevent two severe birth defects: spina bifida and anencephaly. Spina bifida is a condition in which the spinal cord is exposed. During the first 28 days after fertilization, the bones of the spinal column must close properly around the spinal cord. If they do not, the spinal cord or spinal fluid will bulge through the spine, often at the lower back, causing health issues and sometimes requiring surgery.  

Anencephaly is a neural tube defect in which a baby is born without significant portions of the brain and skull. Although the baby may live for a few hours or days after birth, the condition is fatal. 

Researchers have begun studying the effects of folic acid on preventing other issues, such as congenital heart defects, cleft palate, and preterm birth. 

After a 20-year collaborative study from the CDC and the Peking University Health Science Center in China, researchers found that women given 400 micrograms of folic acid before and during pregnancy saw a significant drop in the occurrence of neural tube defects.   

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