If you’re thinking about getting pregnant, then it’s time to be preparing your body for pregnancy. Even with healthy eating, it’s challenging for women hoping to become pregnant to have the right amount of nutrients they need to nourish their baby from their diet alone.
“What vitamins and supplements should I be taking?” is one of the first questions many new patients ask me during their initial office visit. Folic acid should be at the top of that list.
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Folic acid and a healthy baby
Folic acid is very effective at preventing major birth defects in the baby’s spine and brain and possibly other organs such as the face and heart. The neural tube, which later becomes the brain and spine, forms during the first few weeks of pregnancy. Neural tube defects, such as spina bifida, occur when the neural tube doesn’t close properly when the embryo is developing. Folic acid helps the neural tube develop properly and significantly reduces the risks of having a baby with birth defects.
Because many pregnancies in the U.S. are unplanned, expert panels recommend all reproductive age women take 0.4 milligrams (400 micrograms) of folic acid daily so that folic acid levels are adequate whenever pregnancy occurs. Waiting to start folic acid supplementation until pregnancy occurs is not ideal, because many pregnancies are diagnosed once they are several weeks along and the organs are already forming.
Folic acid and fertility
I encourage my patients to take folic acid supplements because it is one of the most important supplements to prepare your body for pregnancy. Different expert consensus panels recommend different amounts of supplementation, some calling for higher levels in the range of 400-800 micrograms daily. Most prenatal vitamins contain 800-1,000 micrograms/tablet, given that folic acid needs are even higher in pregnancy.
Some studies have shown that certain groups of women benefit from even higher amounts of folic acid, including women struggling with obesity, malabsorption disorders, those with a history of a child affected with a neural tube disorder and those taking medications, such as seizure medications, that can increase the risk of a neural tube disorder.
“What is the difference between folic acid and folate?” is another common question from my patients. These terms are used interchangeably, but folate is actually vitamin B9 and folic acid is the synthetic form of that vitamin. Folic acid is used in vitamin supplements and in enriched foods like grains, rice, bread, pasta and cereals. Folate is found in fruits, leafy vegetables and beans.
I tell my patients to eat a healthy diet of food rich in a variety of plants to get adequate folate as well as other antioxidants and nutrients. But most women cannot reach the recommended daily dose of folate eating a healthy diet alone. That’s where folic acid supplements help.
How much folic acid do you need? If you are a healthy woman trying to conceive, start a prenatal vitamin now, which will provide an ample amount of 800-1,000 micrograms/daily in addition to other essential vitamins and nutrients such as B6, B12, iron and vitamin D. If your prenatal vitamin only contains 400 micrograms, do not take two vitamins each day, rather, take a folic acid supplement (taking numerous multivitamins can cause problems with vitamin overdose).
If you have had a prior child with a neural tube defect or are on medications that may increase the risk of malformations, take 4.0 milligrams daily under supervision of your doctor. If you have certain variants in the methylene tetrahydrofolate reductase (MTHFR) gene, you may need broken down folic acid (methylfolate) with vitamins B6 and B12, and you should speak to your doctor about the value of supplements.
Optimizing my patient’s health by starting nutritional supplements, minimizing medication use and achieving a healthy pre-pregnancy weight all help ensure that they have the best chance of delivering a healthy baby.