Facts About Folic Acid
Folic acid, a B-vitamin, is necessary for proper cell growth and development
of the embryo. Folic acid in a vitamin supplement, when taken one month before
conception and throughout the first trimester, has been proven to reduce the
risk for a Neural Tube Defect (NTD)-affected pregnancy by 50 to 70 percent.
Although it is not known exactly how folic acid works to prevent NTDs, its role in tissue formation is essential. Folic acid is required for the formation of DNA, which is necessary for rapid cell growth needed to make fetal organs early in pregnancy.
"Folate" and "folic acid" are different terms for the same B-vitamin. Folate is the B-vitamin form found naturally in foods. Folic acid is the synthetic B-vitamin form that is used in vitamin supplements and added to fortified foods. The body can absorb and use the folic acid found in vitamin supplements more efficiently than it can convert the food folate into a usable form. Synthetic folic acid is about twice as absorbable as naturally occurring food folate.
When do women need to take folic acid?
Women need to get enough folic acid every day throughout their reproductive
years. To prevent NTDs, a woman must take folic acid daily at least one month before she conceives and continue taking it through the first trimester. All women capable of becoming pregnant - not just those planning a pregnancy - should consume enough folic acid every day, as half of all pregnancies in the United States are unplanned. NTDs occur before many women know that they are pregnant.
How much folic acid is needed?
- In 1992, the U.S. Public Health Service (PHS) recommended that all women of childbearing age consume 400 micrograms (0.4 milligrams) of folic acid every day to reduce their risk of having an NTD-affected pregnancy.
- For women who have had an NTD-affected pregnancy, the PHS recommends consulting with a physician about taking a much larger amount of folic acid, i.e., 4000 micrograms (4 milligrams), starting one month before conception and continuing throughout the first trimester.
- In 1998, the Institute of Medicine recommended that to reduce their risk for an NTD-affected pregnancy, women capable of becoming pregnant should take 400 micrograms of "synthetic folic acid" daily, from fortified foods or supplements or a combination of the two, in addition to consuming food folate from a varied diet.
For more information, contact your local chapter of March of Dimes, or the Reproductive and Perinatal Health Services,
Maternal, Child and Community Health Services, Division of Family Health Services, at (609) 292-5616 for the location of the Maternal and Child Health consortium/coalition serving your area.
Are childbearing age women getting enough folic acid?
Two-thirds of childbearing age women in the United States report
consuming insufficient levels of folic acid, even though there are several
ways to get 400 micrograms (0.4 milligrams) of folic acid a day. There
are three ways childbearing age women can get enough folic acid to
prevent spina bifida (open spine), and anencephaly (a lethal defect
involving the brain and skull), as follows:
- Take a vitamin supplement containing 400 micrograms of folic acid
Taking a vitamin supplement containing folic acid is an easy way to
get enough folic acid. Almost all over-the-counter multivitamins contain
400 micrograms of folic acid, the amount recommended to prevent NTDs
(Neural Tube Defects) in childbearing age women. Women should understand
that taking too many vitamin supplements is not good for them or their
babies. Caution should be taken to prevent the excessive use of
multivitamin supplements as, for example, too much vitamin A may cause
other types of birth defects.
- Eat a fortified breakfast cereal daily which contains 100 percent
of the recommended daily amount of folic acid, or 400
A few cereals have enough added folic acid per serving to meet 100
percent of a woman's daily need. Fortified breakfast cereals that contain
100 percent of the recommended daily amount of folic acid are good options
for women who do not want to, or are unable to take a vitamin supplement.
- Increase consumption of foods fortified with folic acid, in
addition to consuming food folate from a balanced diet.
Effective January 1, 1998, the Food and Drug Administration (FDA)
ordered that all enriched cereal or grain products be fortified at a level
of 140 micrograms (0.14 milligrams) of folic acid per 100 grams of grain
product. While this level of fortification offers some protection against
NTDs, most women will not get enough folic acid through fortified grain
products alone. In addition to getting 400 micrograms of folic acid,
women should consume a variety of food folates. Foods rich in folate
include orange juice from concentrate, dark-green leafy vegetables such as
spinach, broccoli, asparagus, romaine lettuce, beans, grains; citrus and
fruits such as kiwis and strawberries as well as liver.
Women capable of becoming pregnant who eat a healthy diet still need
to take a vitamin supplement, eat a breakfast cereal containing 100
percent of the daily value of folic acid per day, or increase their
consumption of foods fortified with folic acid to achieve the recommended
amount of folic acid for the prevention of NTDs.
For more information, contact your local chapter of March of Dimes, or the
Perinatal Health Services Program, MCCH, Division of Family Health Services,
at 609-292-5616 for the location of the MCH consortium/coalition serving your
Can women get too much folic acid?
If a woman of reproductive age were to eat a bowl of fortified cereal containing
100 to 400 micrograms of folic acid, take a vitamin containing 400 micrograms of
folic acid, and eat foods rich in folate in one day, she would not have a problem with too much folic acid. Even in very high amounts, folic acid is nontoxic. Nevertheless, with the exception of women who have had a prior Neural Tube Defect (NTD)-affected pregnancy, it is recommended that women consume no more than 1,000 micrograms of synthetic folic acid a day.
What do these options mean to women?
A diet rich in food folate is healthy and highly recommended. There are a few studies that suggest food folate may reduce the risk for NTDs. However, this is still in question. The Public Health Service recommendation for NTD prevention is based on studies of synthetic folic acid from supplements that women took in addition to their regular diets. Fortifying the food supply is an excellent way to increase consumption of folic acid without requiring women to change their behaviors. However, fortification at the 1998 level will not prevent all folic acid-preventable NTD-affected pregnancies, unless women are educated to change the way they eat.
Very large amounts of folic acid may hide the ability to quickly diagnose a vitamin B12 deficiency, a sign of pernicious anemia. This disease can lead to serious brain and nerve damage if not treated with vitamin B12. Pernicious anemia is rare in young and middle-aged people. Today, physicians can use a series of definitive tests to check individuals for a vitamin B12 deficiency, even when large amounts of folic acid are present.
How to reduce the risk of NTDs?
To help reduce the risk of Neural Tube Defects by 50-70 percent, women will
need to take a folic acid-containing vitamin daily, eat a fortified breakfast
cereal 100 percent of the daily value of folic acid, or increase their
consumption of foods fortified with folic acid in addition to consuming food
folate from a balanced diet.
For more information, contact your local chapter of March of Dimes, or the Reproductive and Perinatal Health Services, Maternal, Child and Community Health Services, Division of Family Health Services, at (609) 292-5616 for the location of the Maternal and Child Health consortium/coalition serving your area.