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      Folic Acid Summary

      About Folate/Folic Acid 

      Folate is a water-soluble B vitamin. Folate is a term used for both naturally occurring food folate and folic acid, which is used in dietary supplements and fortified foods. Folic acid is available as a supplement or as part of most multivitamins.  

      Folic Acid for Preconception Care 

      To prevent serious birth defects, women of childbearing age (typically 15-45 years) should obtain 400 micrograms (mcg) of folic acid per day from dietary supplements or multivitamins in addition to the folate present in a varied diet. 

      • Data has shown that up to 70% of serious birth defects of the spine (spina bifida), skull and brain (anencephaly)—known as neural tube defects (NTD)—can be prevented by adequate levels of folic acid at the time of conception and throughout pregnancy.  
      • The neural tube closes 28 days after conception. 
      • Half of all pregnancies in the U.S. are not planned. Often, by the time a woman realizes she is pregnant, the neural tube has been formed, and the window of opportunity to prevent NTD is missed. 

      Consuming Enough Folic Acid 

      For most women, obtaining sufficient folic acid through food to reduce the risk of NTD is difficult; therefore, supplementation is necessary.  

      Food sources:

      • Good food sources of folate include orange juice, peanuts, asparagus, brussels sprouts and dark green leafy vegetables, such as spinach. 
      • In the U.S., foods such as enriched breads, cereals, flours, pastas, rice and other grain products are fortified with folic acid.  

      Supplementation 

      All women who are capable of pregnancy should be advised to take either a multivitamin or folic acid tablet containing 400 mcg of folic acid—regardless of their intention to become pregnant or current use of contraceptives. The recommended dose is not associated with serious harm. 

      • Some women may have barriers to multivitamin use (e.g., upset stomach); in these instances,  
        the folic acid tablet may be preferred. 
      • For pregnant women with standard risk of NTD, the recommended dose of folic acid is 600 mcg/day. 
      • A higher dose of folic acid before pregnancy (up to 4-5 mg/day) and increased monitoring may be appropriate for women: 
        • With certain conditions, such as diabetes, obesity, or previous pregnancy with a NTD 
        • Using phenytoin, carbamazepine, primidone, phenobarbital or valproic acid/derivatives  

      Counseling 

      When making recommendations and counseling patients, it is important to note that most healthcare professionals do not talk with women about folic acid, but women are generally receptive.  

      • Women who are not planning a pregnancy in the near future are typically quite concerned about their overall health and well-being. Therefore, the health benefits of the intervention for the woman should be stressed. For example, promoting the health benefits of multivitamins/folic acid will be important. 
      • For women who are planning a pregnancy in the near future, stress the benefits to infant outcomes. For example, when making the recommendation for an intervention, counsel them about the increased risk of birth defects with insufficient folic acid use. 

      Additional information