Folic Acid FAQs

• What is folic acid and where can I get it?
• When should I start taking folic acid?
• What are neural tube defects (NTDs)?
• What are spina bifida and anencephaly?
• Who can have a baby with a neural tube defect in the United States?
• Can women get too much folic acid?
• Are women getting enough folic acid?
• What are other health benefits to taking folic acid?
• What if I've already had a pregnancy affected by NTDs?

What is folic acid and where can I get it?

Folic acid is a B-vitamin. The recommended amount to prevent spina bifida and other neural tube defects is 400 micrograms (0.4 milligrams) of synthetic folic acid daily. There are two easy ways to be sure to get enough folic acid each day:

1. Take a vitamin that has folic acid in it every day.

   Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day.

   Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg).

2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day.

   Not every cereal has this amount. Check the label on the side of the box, and look for one that has "100%" next to folic acid.

      

When should I start taking folic acid?

For folic acid to help prevent major birth defects, a woman needs to start taking it at least one month before she becomes pregnant and while she is pregnant.

However, every woman needs folic acid every day, whether she's planning to get pregnant or not, for the healthy new cells the body makes daily. Think about the skin, hair, and nails. These - and other parts of the body - make new cells each day.

      

What are neural tube defects (NTDs)?

Between the 17^th and 30^th day after conception (or 4 to 6 weeks after the first day of a woman's last menstrual period), the neural tube forms in the embryo (developing baby) and then closes. The neural tube later becomes the baby's spinal cord, spine, brain, and skull. A neural tube defect (NTD) occurs when the neural tube fails to close properly, leaving the developing brain or spinal cord exposed to the amniotic fluid. The two most common neural tube defects are anencephaly and spina bifida.

      

What are spina bifida and anencephaly?

Spina bifida and anencephaly are birth defects that occur in the first four weeks of pregnancy, before most women know that they are pregnant. Because about half of all pregnancies are unplanned, it is important to include 400 micrograms of folic acid in every childbearing age woman's diet.

Spina bifida occurs when the lower end of the neural tube fails to close. Thus, the spinal cord and back bones do not develop properly. Sometimes, a sac of fluid protrudes through an opening in the back, and a portion of the spinal cord is often contained in this sac. Paralysis of the infant's legs, loss of bowel and bladder control, water on the brain (hydrocephalus), and learning disabilities are among the disabilities associated with spina bifida. Eighty to ninety percent of infants born with spina bifida live. Despite varying degrees of disability, many lead successful and productive lives.

Anencephaly is a fatal condition in which the upper end of the neural tube fails to close. In these cases, the brain either never completely develops or is totally absent. Pregnancies affected by anencephaly often result in miscarriages. Infants who are born alive die very soon after birth.
 

      

Who can have a baby with a neural tube defect in the United States?

Sixty million women are of childbearing age in the United States; all those who are capable of becoming pregnant are at risk for having an NTD-affected pregnancy. It is not possible to predict which women will have a pregnancy affected by an NTD. Ninety-five percent of NTDs occur in women with no personal or Family history of NTDs. However, some risk factors are known:

• An NTD-affected pregnancy increases a woman's chance to have another NTD-affected pregnancy approximately twenty times.
• Maternal insulin-dependent diabetes
• Use of certain anti-seizure medication (Valproic acid/Depakene, and Carbamazapine/Tegretol.)
• Medically diagnosed obesity
• High temperatures in early pregnancy (i.e., prolonged fevers and hot tub use)
• Race/ethnicity (NTDs are more common among white women than black women and more common among Hispanic women than non-Hispanic women)
• Lower socio-economic status

      

Can women get too much folic acid?

Unless their doctor advises them to take more, most women should limit the amount they take to 1,000 mcg a day. However, some women need more folic acid, especially if they are trying to get pregnant. For example, women who have had a previous pregnancy affected by birth defects of the brain and spine and women with sickle cell disease should be sure to talk with their doctors about the need for more folic acid.

      

Are women getting enough folic acid?

Even though there are several ways to get 400 micrograms (0.4 milligrams) of folic acid every day, two thirds of women in the United States do not consume enough folic acid.

      

What are other health benefits to taking folic acid?

High levels of the amino acid homocysteine are independently associated with an increased risk of heart disease and stroke. It has been shown that taking folic acid lowers homocysteine levels in both men and women, but it is not yet known whether folic acid supplementation also lowers the risk of heart disease and stroke.

There are some indications that folic acid use may also reduce the risk for other birth defects, such as cleft lip and palate and certain congenital heart defects. Folic acid may also play a role in protecting against some forms of cancer and heart disease. More research is needed to understand the impact of folic acid in preventing those diseases and other birth defects.

      

What if I've already had a pregnancy affected by an NTD?

If you have already had a pregnancy affected by NTDs, you are at higher risk for having another pregnancy affected by NTDs. The U. S. Public Health Service (USPHS) recommends that you take 400 micrograms (0.4 milligrams) of folic acid every day if you are not planning to become pregnant. If you plan to become pregnant, you should consult your health care provider about the desirability of using 4 milligrams (4000 micrograms) of folic acid daily beginning one month before you start trying to get pregnant and continuing through the first three months of pregnancy. Although it appears that a lower dose, such as 0.4 milligrams, may have as great a beneficial effect as 4.0 milligrams, many health care providers recommend the higher dose. This recommendation is based on information from a rigorous scientific study involving women who had previous pregnancies affected by NTDs. This dosage should be prescribed and monitored by your health care provider. Typically, a health care provider will prescribe one prenatal vitamin plus three 1 mg tablets of folic acid a day to get this dosage. You should not take more than one prenatal or other multivitamin a day to get increased folic acid, because too much vitamin A can be harmful for the baby. Keep in mind that we do not understand all the causes of neural tube defects. We do know that 50%-70% can be prevented by consuming sufficient amounts of folic acid.

      

For more information, see:
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