The Facts on Folate

Why this vitamin is so important to your baby's health.


One of the most important things you can do for your unborn child is plan ahead. Not by painting the nursery or choosing a name, but by supplementing your diet with folic acid. And experts say the best time to do it is before conception.

According to the American Academy of Pediatrics, studies show that adding a daily dose of 400 micrograms (.4 milligram) of folic acid to your diet at least one month before you become pregnant — and increasing to 600 micrograms once you suspect you are pregnant, continuing throughout the first trimester of pregnancy — can cut the risk of neural-tube defects (NTDs) in newborns by half. But a recent Gallup survey found that despite increased public awareness about the importance of this B vitamin, only about one-third of American women take supplements containing folic acid daily. So why the disconnect?

"There's been a significant increase in awareness of folic acid over the past five years," says Jennifer L. Howse, Ph.D., president of the March of Dimes. But, she adds, although 75 percent of women surveyed this past spring were familiar with folic acid, only 14 percent knew that it helps prevent birth defects — and only 10 percent knew it should be taken before pregnancy. (Folic acid is vital to a fetus's development because it aids in the process of cell division and the development of healthy tissue.)

The reason folic acid is so vital pre-conception is that the neural tube — the part of the embryo that evolves into a baby's brain and spinal cord — forms in the first four weeks after conception. Since almost half of all pregnancies in the United States are unplanned, it's important to start taking folic acid early on so the levels in your blood are properly elevated at the time of conception and just after.

Diet and birth defects If all of this seems like a lot of fuss over a vitamin supplement, consider this: NTDs are among the most common serious birth defects, occurring in 1 out of 1,000 births each year. According to the AAP, 4,000 U.S. pregnancies are affected by NTDs annually, resulting in 2,500 infants born with grave, even fatal disabilities such as anencephaly, in which babies are born with severely underdeveloped brains and skulls; and spina bifida, which causes varying degrees of paralysis, as well as learning disabilities, mental retardation, and bladder- and bowel-control problems. The other 1,500 pregnancies affected by NTDs either spontaneously abort or are terminated. (NTDs occur 45 to 50 percent more frequently in the Hispanic community than in the general population.)

Researchers first discovered a link between NTDs and diet in the 1950s; 40 years later, studies led the U.S. Public Health Service to recommend that all women of childbearing age (roughly 15 to 45 years old) consume 400 micrograms of folate daily to reduce the incidence of NTD-affected pregnancies.

Although folate, the natural form of folic acid, is found in citrus fruits and juices, dark green leafy vegetables, asparagus, beans, broccoli, lentils, peas, peanuts and whole-grain products, most women in the United States get only about 200 micrograms daily — just half the recommended dose — from the foods they consume. The synthetic form — folic acid — is more reliable and easily absorbed by the body, which is why most multivitamins contain the recommended daily value of it.

How much to take?

Supplemental folic acid has been found to be even more important for women who already have had an NTD-affected pregnancy. Research shows that a much larger dose of folic acid — 4,000 micrograms, or 4 milligrams — taken daily beginning a month before conception reduces recurrences by 71 percent. But such a large dose requires a prescription: Simply taking 10 times the usual number of multivitamins could lead to an overdose of some vitamins. Women who are candidates for the higher dose should also be screened for pernicious anemia, a condition that can be masked by large amounts of folic acid.

The best advice is to check your diet to make sure you're getting both synthetic folic acid and naturally occurring folate. "I tell my clients to pick a 'Folate Friday' and do a mini-check to see how much they're getting," says Edith Howard Hogan, R.D., L.D., a dietitian in Washington, D.C., and spokeswoman for the American Dietetic Association. "They should take a multivitamin, but they also need to check the nutrition panel on the foods they're eating." Hogan recommends folate-rich snacks like hummus on a whole-wheat pita, orange juice and lentils, which can be enjoyed in soup or as a salad in the summer. "I tell my clients to drink a cup of orange juice with their lentil salad, and they're getting a two-fer," she adds.

Adding folic acid to your diet may have other health benefits as well. "Folic acid is vital for the production of new and healthy red blood cells," says Hogan. And new research suggests that folic acid may help prevent other health risks, such as heart disease and certain cancers. So pour yourself another glass of orange juice — and put lentils on the shopping list.