Folic acid during pregnancy: what is important to know?

Folic acid during pregnancy is essential for the normal development and the prevention of fetal defects. Why is this vitamin so important? Why is it important to start taking it even before getting pregnant? What is the recommended dose for women at low risk? And what about high-risk women? all the answers

Folic acid deficiency can cause various malformations in the fetus, especially in the brain and spinal cord (neural canal).

It is recommended to start taking folic acid starting at least three months before pregnancy and continue until delivery.

Low-risk women should take 400 mcg a day. For high-risk women, the doctor determines the dose.

Folic acid during pregnancy deficiency may cause various defects in the fetus, mainly in the brain and spinal cord (neural canal), but also in other systems such as the heart and digestive system. These are severe defects, which can cause diseases, severe disability and even death of fetuses and newborns.

An appropriate level of folic acid during pregnancy in the body may significantly reduce the risk of developing these defects. Since the neural canal develops early during pregnancy (about 18 days after fertilization), it is important to have a sufficient level of folic acid even then. This is a stage where the woman is often not yet aware that she is pregnant.

When is it recommended to take?

How long before pregnancy should you take it?

It is recommended to start taking folic acid at least 3 months before pregnancy as part of the preparation for it.

Taking folic acid during pregnancy is especially important in the first trimester, because during this period the organs of the fetus are formed and developed.

The Ministry of Health recommends that all women of childbearing age (especially women who do not use contraceptives ) take a folic acid supplement every day, because the pregnancy is not always planned, and the woman is not always aware from the beginning that she is pregnant.

What dose of folic acid is recommended to take?

First of all, it is important to clarify that you should not take a higher dose than recommended without a medical recommendation.

In general, the recommended amount is 400 mcg (0.4 mg) of folic acid per day. All women of childbearing age are recommended to swallow a tablet (pill) containing this amount of folic acid once a day.

If it is a pregnancy in which there is only a low risk of the development of a fetus that suffers from an open defect in the neural canal  – 400 mcg per day of folic acid during pregnancy is recommended dose. 

If it is a pregnancy with a high risk of  developing a fetus that suffers from an open malformation in the neural canal  – a 10 times higher dose of folic acid during pregnancy is needed, i.e. 4 mg (4,000 mcg).

Since 5 mg preparations are marketed in Israel, the Ministry of Health recommends that women at risk who may become pregnant take folic acid during pregnancy at a dose of 5 mg (5,000 mcg) starting at least one month before trying to conceive and for the first three months of pregnancy.

Since this dose may mask signs of anemia due to a lack of vitamin B12 , it is recommended to also take vitamin B12 in a dose of 3 mcg per day or make sure to check its blood level.

The following women are included in the risk group for pregnancy with a fetus with an open neural tube defect:

• Those who in the past had an open neural canal malformation discovered in their fetus or newborn, or they themselves or the baby’s father were born with such a malformation, or they have a family history of a neural canal malformation. 

• Those receiving drug treatment against epilepsy or those being treated with lithium or methotrexate .

• Those who have pre- gestational diabetes (that is, those who have diabetes before becoming pregnant).

• For those who are overweight ( BMI of 30 or more).

• For those who suffer from diseases that may impair absorption in the intestines such as Crohn’s disease or celiac disease .

• For those who consume alcohol excessively.

If you belong to one or more of these risk groups, it is important that you report this to your doctor in order to adjust the required dose of folic acid. 

Can you take Farental instead of folic acid during pregnancy?

Most women take during pregnancy a multivitamin preparation that is suitable for pregnant women (such as Parental ) or an iron pill combined with folic acid (such as Folex ).

You need to make sure that the product you are taking contains the recommended amount of folic acid. If the preparation contains the recommended amount and you do not belong to one of the risk groups for a fetus with an open neural tube defect, there is no need to take additional folic acid separately.

Why is it important to take folic acid before pregnancy and folic acid during pregnancy even if the values ​​are normal?

In principle, there is no need to routinely check the level of folic acid before or during pregnancy. The reason: even if the values ​​in a blood test are normal – and even more so if there is a deficiency and the level of folic acid in the blood is low – there is a blanket recommendation to take a folic acid supplement before pregnancy and during pregnancy.

What is the significance of not taking folic acid during pregnancy or before?

Although the risk of defects caused by a lack of folic acid is low overall, in the absence of an orderly intake of folic acid during pregnancy, as mentioned, the risk of defects in the nervous system increases. Since folic acid does not have storage reserves in the body, it is important to take it regularly and continuously.

On top of that, the folic acid works to prevent anemia in the woman during pregnancy.

However, it must be remembered that not all defects in the neural canal develop due to a lack of folic acid. There are defects that develop due to other problems such as maternal diabetes or genetic syndromes of the fetus.

Why is folic acid in food not enough?

The following foods contain folic acid:

• Green leafy vegetables (such as lettuce, cabbage and spinach).
• Citrus fruits.
• Legumes and whole grains.
• Foods enriched with folic acid such as rice, pasta and bread.

However, it is important to know that only 50% of the amount of folic acid found in food is absorbed by the body. Also, cooking and storage also impair the effectiveness of the vitamins in the food and reduce the absorbed amount to only about 10%. Therefore, the natural folic acid in these foods is not a substitute for taking a synthetic folic acid supplement that is absorbed by the body almost 100%.