What is folic acid?

Folic acid is one of the B group of vitamins – it is known as vitamin B9 and is also referred to as folate. Folic acid has an important role in ensuring healthy cell growth and development; however, it becomes even more important prior to conception and during the early weeks of pregnancy. Conclusive research evidence has existed for over 20 years, which shows that an adequate daily consumption of folic acid before and during the early weeks of pregnancy, promotes the healthy development of the fetal brain and spinal cord. Research shows that adequate folic acid intake considerably reduces the risk for neural tube defects (NTDs).

What are neural tube defects (NTDs)?

NTDs affect over 900 pregnancies in the UK each year, which equates to 1 in 1000 pregnancies. NTDs include, spina bifida, anencephaly and encephalocele. These are serious birth defects of the brain and spine that occur during the first month of pregnancy, when the neural tube fails to close completely.
Spina bifida is a condition where there is incomplete closing of the vertebrae (backbone) and the membranes surrounding the spinal cord. The condition often leads to lifelong disability and most people affected are wheelchair users.
Anencephaly is a condition where the baby’s brain and skull fail to form properly – it is almost invariably incompatible with life outside the womb and fatal.
Encephalocele is a condition characterised by a sac-like protrusion of the baby’s brain and the membranes that cover it through openings in the skull. The severity of the condition depends on its location.

NB. Most NTDs can be prevented if women receive enough folate before and during pregnancy. A study undertaken by the Medical Research Council in 1991 found that folic acid could help prevent the number of pregnancies affected by a NTD by up to 72%.

What are the folic acid recommendations for pregnancy?

The Department of Health recommends that women should take a daily supplement of 400 micrograms (400mcg) of folic acid while they are trying to conceive (ideally for at least three months

prior to conception), and should continue taking this dose for the first 12 weeks of pregnancy. This is the period when the baby’s brain and spine are developing. However, it is safe to continue taking folic acid supplements beyond 12 weeks of pregnancy.

But I’m already pregnant…?

Around half of all pregnancies in the UK are unplanned, so it is recommended that women ensure they are as healthy as they can be, just in case they do become pregnant. Consequently, it is recommended that all women of a childbearing age, take 400mcg of folic acid daily whether this is as part of a multivitamin, or as a single supplement.

If you didn’t take folic acid supplements before getting pregnant and are less than 12 weeks pregnant, the Department of Health recommends that you start taking folic acid as soon as you know you’ve conceived.

Folic acid and high-risk pregnancies

Some women are considered to be at greater risk of having a pregnancy affected by a NTD. This can be because the woman or their partner have NTDs themselves; they have had a previous pregnancy affected by a NTD; there is a family history of NTDs; the woman has diabetes or coeliac disease, or is taking anti-epilepsy medication.

Where this is the case, the Department of Health recommends that women take a higher daily dose of folic acid – 5 milligrams (5mg) whilst trying for a baby and until they are 12 weeks pregnant. This dose of folic acid is only available on prescription from your GP, so it is advised that you see your GP early for their advice before trying to get pregnant.

If you are at a higher risk of having a pregnancy affected by a NTD, your GP and midwife may recommend additional antenatal screening tests in pregnancy to keep a closer eye on your baby’s development.

How do I ensure I’m getting enough folic acid?

Folic acid supplements – You can get folic acid supplements in tablet form from your local pharmacy/chemist, most of the large supermarkets, health food stores, or on prescription from your GP. One folic acid tablet, taken daily, contains precisely the right amount of folic acid that the Department of Health recommends for the healthy development of your baby’s brain and spine.

Folate-rich foods – There are a number of foods that are rich in folic acid; these include green, leafy

vegetables such as spinach, curly kale, broccoli, brussels sprouts, savoy cabbage and asparagus – the darker green the leaves, the better!
Folic acid is also found in brown rice, breakfast cereals which are fortified with folic acid, as well as whole-wheat products such as granary bread. It is also found in dried beans, lentils, peas and oranges.You can check the folic acid content of different foods by checking the product’s food labels.

Food safety

Liver is also very rich in folic acid, however it is not safe to eat while you are pregnant or trying to become pregnant. This is because liver contains abnormally high levels of vitamin A (called ‘retinol’) which has been linked to babies being born with birth defects. For further information see, ‘Healthy eating for you and your baby’.

Is eating folate-rich foods sufficient?

Whilst eating foods that are rich in folic acid is very beneficial to you and your developing baby, studies have found that it is virtually impossible to receive sufficient amounts of folic acid through

diet alone. Consequently, the best way of ensuring that you get the recommended 400mcg intake of folic acid is to take a daily supplement.

Are there any additional benefits to taking folic acid?

More recent research has demonstrated that folate supplementation has an important role in maintaining health for your baby during pregnancy, right through into childhood and beyond, with emerging research indicating folate can prevent chronic disease in later life. Of particular interest is the link between folate and brain health during ageing and the longer term effect of folate exposure in pregnancy on children’s cognitive development.

Go Folic!

Go Folic! Launched in 2010 and is a national campaign that aims to inspire all women of a child-bearing age to take 400mcg of folic acid each day before they become pregnant. For more information visit: www.gofolic.org.uk.

Ami N, Bernstein M, Boucher F et al (2016). Folate and neural tube defects: The role of supplements and food fortification. Paediatrics & Child Health 21(3):145-154.

Atta CAM, Fiest KM, Frolkis AD et al (2016). Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis. American Journal of Public Health 106(1):10.

Balogh V (2014). From Womb to World: Folic Acid and Iron Benefits and Future Health Implications. International Journal of Childbirth Education 29(3):38-41.

Binns C, Scott J, Nwafor N et al (2006). Which mothers take folic acid and folate containing foods? Asia Pacific Journal of Clinical Nutrition 15(3):335-340.

Brough L, Rees GA, Crawford MA et al (2009). Social and ethnic differences in folic acid use preconception and during early pregnancy in the UK: effect on maternal folate status. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association 22(2):100-107.

Cordero AM, Crider KS, Rogers LM et al (2015). Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: world health organization guidelines. MMWR: Morbidity & Mortality Weekly Report 64(15):421-423.

De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC et al (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. The Cochrane Database of Systematic Reviews, Issue 12.

Douglas Wilson R, Audibert F, Brock J-A et al (2015). Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. Journal of Obstetrics and Gynaecology Canada 37(6):534-549.

Dunney C, Murphy DJ (2015). Healthy lifestyle behaviours in pregnancy: A prospective cohort study in Ireland. British Journal of Midwifery 23(12):874-884.

Elkin AC, Higham J (2000). Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels. BJOG: An International Journal of Obstetrics and Gynaecology 107(2):285-289.

Gille D, Schmid A (2015). Vitamin B12 in meat and dairy products. Nutrition Reviews 73(2):106-115.

Gomes S, Lopes C, Pinto E (2016). Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO. Public Health Nutrition 19(1):176-189.

Hodgetts VA, Morris RK, Francis A et al (2015). 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 122(4):478-490.

Hunt K (2015). Focus on women’s health preconceptual care. Practice Nurse 45(5):26-32.

Lucas C, Charlton K, Yeatman H (2014). Nutrition Advice During Pregnancy: Do Women Receive it and Can Health Professionals Provide it? Maternal & Child Health Journal 18(10):2465-2478.

McNulty H, Ward M, Hoey L et al (2015). Achieving optimal folate status for health in European populations. Annals of Nutrition and Metabolism 67(12).

Novak B (2007). Health benefits of folic acid. Nurse Prescribing 5(5):215-220.

Obeid R, Oexle K, Rißmann A (2016). Folate status and health: challenges and opportunities. Journal of Perinatal Medicine 44(3):261-268.

Satter-Maloy KL (2016). Preconception Nesting: Optimizing Maternal Health Before and During Your Baby’s Gestational Period. Nutritional Perspectives: Journal of the Council on Nutrition 39(3):37-40.

Stern SJ, Matok I, Kapur B et al (2012). Dosage Requirements for Periconceptional Folic Acid Supplementation: Accounting for BMI and Lean Body Weight. Journal of Obstetrics and Gynaecology Canada 34(4):374-378.

Taylor CM, Atkinson C, Penfold C et al (2015). Folic acid in pregnancy and mortality from cancer and cardiovascular disease: further follow-up of the Aberdeen folic acid supplementation trial. Journal of Epidemiology & Community Health 69(8):789-794.

Tennant GA (2014). Nutrition and Pregnancy: Folate and Folic Acid. International Journal of Childbirth Education 29(3):25-28.

Wen SW and Walker M (2005). An Exploration of Health Effects of Folic Acid in Pregnancy Beyond Reducing Neural Tube Defects. Journal of Obstetrics and Gynaecology Canada 27(1):13-19.

Wyness L (2015). Vitamin supplementation and nutrition during pregnancy and breastfeeding. British Journal of Midwifery 23(10):695-701.