Finding Folate

One of the simplest ways to help prevent crippling birth defects is to get enough of this B vitamin.


As a mom-to-be, you want to protect your baby from harm at all costs. Cut out alcohol? No problem. Stay away from raw fish? You bet. But safeguarding your baby isn't all about what you "can't" have or "shouldn't" do. In the case of birth defects, it's crucial that you add a key nutrient to your diet: folate.

In 1991, British researcher Nicholas Wald linked consumption of the B vitamin to a reduction in neural-tube defects (NTDs), including spina bifida and anencephaly. Spina bifida ("open spine") can cause lifelong disabilities, including lack of bowel control and lower-body paralysis. Babies with anencephaly, in which part or all of the brain is missing, die before or shortly after birth.

Prompted by Wald's pioneering work, the U.S. Food and Drug Administration in 1998 ordered cereal manufacturers to fortify their products with folic acid (the synthetic form of folate, found in supplements and fortified foods). The result was a boon for pregnant women: a 43 percent reduction in the number of babies born with crippling NTDs.

Start Taking it ASAP

For folate to confer the greatest benefits, you need to supplement before conceiving. Birth defects of the spine and brain occur in the first weeks of pregnancy, often before a woman even realizes she's expecting. Because nearly one-half of pregnancies in the U.S. are unplanned, the current Institute of Medicine recommendation is that all women who are capable of becoming pregnant get 400 micrograms of folic acid daily from supplements and fortified foods in addition to their intake of folate from a varied diet.

Once pregnancy is confirmed, the IOM recommendation jumps to 600 micrograms per day. Fortified cereals, beans and leafy greens are good sources of folate, and most prenatal vitamins contain 800 to 1,000 micrograms of folic acid.

Benefits for Both of You

Getting adequate folate or folic acid daily, both before and during pregnancy, can reduce your baby's risk of NTDs by 50 percent. But that's not all: A recent study found that women who did not take a prenatal vitamin with folic acid in the months before conceiving or during their first month of pregnancy were nearly twice as likely to have a child with an autism spectrum disorder as women who took a prenatal vitamin.

"We know that folic acid is important for neural development in general and is associated with better cognitive development and behavioral outcomes," says study author Rebecca J. Schmidt, Ph.D., assistant professor in public health sciences at the University of California, Davis. In fact, another recent study found that children of women who took folic acid for four weeks before and eight weeks after conceiving had a reduced risk of severe language delays by age 3.

Research has also found that getting the recommended amount of folate cuts a baby's risk of being born with a cleft lip or cleft palate by one-third. And some science shows that folic acid can reduce a pregnant woman's risk for preeclampsia, a potentially life-threatening blood pressure disorder. The jury is still out on whether folic acid supplementation prevents preterm birth. While some studies show a protective effect, new research finds no such link. More large-scale studies are needed.

The B vitamin is important for other reasons, as well. "Folic acid helps the body maintain and produce new cells," says Dawn Jackson Blatner, R.D., national media spokeswoman for the American Dietetic Association. Every cell of your growing baby's body requires it, and you need it, too: Producing enough red blood cells to prevent anemia—a common problem during pregnancy—is dependent on your getting enough folate.

Why Some Women Need More Folate

Though any woman can give birth to a baby with a neural-tube defect (NTD), a few factors increase the risk: poorly controlled diabetes, obesity, Hispanic or Caucasian ethnicity, and a previous NTD-affected pregnancy. "The recommended dietary allowance for a woman planning a pregnancy after a previous pregnancy complicated by an NTD is 4,000 micrograms a day, which is 10 times the amount recommended for nonpregnant women," says Darios Getahun, M.D., M.P.H., in the department of research and evaluation at Kaiser Permanente Southern California.