Folic Acid: Why So Many Reproductive-Aged Women Still Aren't Getting Enough

According to a new report, many women don't take the recommended amount of folic acid to prevent birth defects. So when should you start? The answer is right now.

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When pregnant women go for their first prenatal checkup, their OBs usually remind them to take folic acid and hand out free samples of prenatal vitamins. But a new report by the U.S. Preventative Services Task Force published in the journal JAMA suggests that's too little, too late. Instead, all women should start taking the vitamin before becoming pregnant—but less than a third are actually doing this.

Pills are a pain, and diet isn't enough

Why this rush to load up on the vitamin? Because folic acid (the synthetic form of folate) helps prevent birth defects that develop in the first month of pregnancy—often before you know you're pregnant. So, the recommendation says women of childbearing age should take 0.4 to 0.8 mg (400-800 mcg) daily, whether you're trying to get knocked up or not. "Because not all pregnancies are planned and because supplementation should begin before conception, women who take a daily supplement ensure that their pregnancies, whether planned or unplanned, benefit," Laura E. Mitchell, PhD, a professor at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health who wrote an accompanying editorial, tells Fit Pregnancy.

Since half of all pregnancies are a surprise, Mitchell says, it makes sense for everyone to take a supplement, just in case—but this isn't actually happening. Let's be honest, taking pills are a pain. And vitamins aren't cheap. Both of these factors are likely reasons why many women aren't bothering, especially if they're not yet planning a family. And even if you mean to take your supplements, it's easy to forget.

Given these inconveniences, in 1998 the FDA had a good idea: to mandate that folic acid be added to grain products like bread, cereal and pasta. Since then the rate of neural tube defects has gone way down (and given us a great excuse to eat carbs). In 2016 the FDA approved fortifying corn masa flour, a common ingredient in tortillas and corn chips, as well. But even so, "it is difficult to ensure that you get sufficient folic acid from your diet alone," Mitchell says. If you're not eating many fortified grains because you're gluten-free or paleo, you might be especially at risk. According to research Mitchell cites, nearly a quarter of reproductive-age women have suboptimal blood folate levels, and those who don't take supplements are three times as likely to have suboptimal levels than those who do.

Don't wait for pregnancy

If you're reading this, you're probably planning a pregnancy or are already pregnant, so you should definitely be taking a supplement. The report says the crucial window is for at least one month before pregnancy and through the first trimester, when the neural tube, which includes the brain and spinal cord, is forming. Without enough of the vitamin, the neural tube can develop improperly and cause birth defects like spina bifida and anencephaly. "If women wait until they know that they are pregnant to start taking folic acid, they may not have adequate levels of folate when the neural tube is developing," Mitchell says. So you TTCers should start now if you haven't already.

You can take supplements either as a separate pill or as part of a multivitamin. Either way, "check the product label to ensure you are taking at least 0.4 mg of folic acid," Mitchell says. If your multivitamin is short, don't double up, because you could get too much of other things—instead, add a stand-alone supplement. Apps like MediSafe Pill Reminder and Tracker can help you remember to take them. However you can manage it, making an effort to take enough is crucial for the health of your future child.