Folic acid, also called folate, is a B vitamin, essential for the division of all body cells and the production of DNA and RNA, the genetic material of life. Without it, nothing can grow—not even a single hair or fingernail—and healing cannot take place. Folic acid is found in orange juice, leafy green vegetables, and beans. The US Food and Drug Administration (FDA) requires folic acid to be added to enriched grains, such as breads, cereals, and pasta.
Through its role in the cellular processes required for normal fetal development, folic acid helps prevent neural tube defects (NTDs). Occurring in about 3,000 births per year, NTDs are among the most serious birth defects in the United States. NTDs occur when the neural tube, which forms the brain and spinal cord, fails to close. Folic acid supports the normal fusion of the neural tube.
NTDs include anencephaly and spina bifida. Anencephaly occurs when a large portion of a baby's brain is not fully formed. This condition is incompatible with life. Spina bifida, which occurs when a fetus's spine does not close completely, is the most common NTD. According to the March of Dimes, the risk of NTDs could be reduced by 70% if women consumed an adequate amount of folic acid. Another study suggests that folic acid may prevent 50% of birth defects across the board, including cleft lip and cleft palate.
These statistics are impressive, but there is a catch: Women must consume sufficient levels of folic acid prior to conception since the neural tube is formed very early in pregnancy. Bolstering folic acid status early, about a month prior to starting to try to conceive, ensures that a woman has an adequate amount in her body at conception.
The problem, however, is that nearly half of all pregnancies in the United States are unplanned. Because of this, the March of Dimes and United States Public Health Service have recommended that all women of childbearing age, including all teenage girls, consume 400 mcg (micrograms) of folic acid each day. Most multivitamins contain this amount, as do some fortified breakfast cereals. Other good food sources include beef liver, black eyed peas, spinach, asparagus, and baked beans.
Other countries also fortify their food with folic acid. Canada, for example, has seen signs of benefit with its fortification program—a decrease in the number of babies born with heart defects, suggesting that folic acid can offer protection beyond neural tube defects. Taking folate and iron may offer additional benefits, like reducing the number of infants born with low birth weight and reducing infant mortality.
If you're not sure if you need folic acid supplements and you do plan on starting a family, make an appointment with your doctor. You and your partner can discuss any risk factors that may affect your pregnancy. Some of these can be determined with simple testing. Your doctor may also suggest certain lifestyle changes to help increase your chance of a successful conception and pregnancy. These may include prenatal vitamins, dietary changes, and quitting smoking and drinking.
Unfortunately, many women are unaware of the recommendations regarding folic acid intake. To help spread the word, one week in January is dedicated as National Folic Acid Awareness Week, a time to spotlight NTD prevention. It's an opportunity to get the word out that some disabling or fatal birth defects are easily preventable.
Recommended daily allowances and adequate intake levels for folate:
|Age||Micrograms (mcg) per day|
|0-6 months||65 mcg|
|7-12 months||80 mcg|
|1-3 years||150 mcg|
|4-8 years||200 mcg|
|9-13 years||300 mcg|
|14 years and older||400 mcg|
|Pregnant women||600 mcg|
|Nursing women||500 mcg|
Here are the tolerable upper intake levels for folic acid from fortified foods or supplements:
|Age||Micrograms (mcg) per day|
|1-3 years||300 mcg|
|4-8 years||400 mcg|
|9-13 years||600 mcg|
|14-18 years||800 mcg|
|Pregnant or nursing women up to 18 years||800 mcg|
|19 years or older||1000 mcg|
|Pregnant or nursing women 19 years and older||1000 mcg|
Women's Health Matters
Christian P, Khatry SK, et al. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: Double blind randomised community trial. BMJ. 2003;326(7389):571.
Folate. Office of Dietary Supplements, National Institutes of Health website. Available at: http://ods.od.nih.gov/factsheets/Folate-HealthProfessional. Updated April 20, 2016. Accesse3d March 29, 2017.
Folic acid keeps you and your baby healthy. March of Dimes website. Available at: http://www.marchofdimes.org/pregnancy/take-folic-acid-before-youre-pregnant.aspx. Updated January 2017. Accessed March 29, 2017.
Honein MA, Paulozzi LJ, et al. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA. 2001;285:2981-2986.
Planning for pregnancy. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/preconception/planning.html. Updated February 13, 2017. Accessed March 29, 2017.
Vitamin supplementation for cardiovascular disease prevention. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T114056/Vitamin-supplementation-for-cardiovascular-disease-prevention. Updated August 23, 2016. Accessed March 29, 2017.
6/5/2009 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T114304/Folate-deficiency: Ionescu-Ittu R, Marelli AJ, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ. 2009;338:b1673.
11/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115517/Breastfeeding: Christian P, Stewart CP, et al. Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: A prospective follow-up in a randomized, controlled community trial. Am J Epidemiol. 2009;170:1127-1136.
Last reviewed March 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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