Folic acid is a B-vitamin that your body needs to make healthy cells that develop normally. Since more than half of pregnancies are unplanned, people who were assigned female at birth and are of reproductive age should take at least 400 micrograms of folic acid every day to help decrease the risk of neural tube defects. The neural tube forms between seventeen- and thirty-days following conception (before many people even know they are pregnant) and is the developing part of a baby that becomes the spinal cord, spine, skull, and brain.
If all people took folic acid every day regardless of whether they are planning a pregnancy, then it could prevent 70% of neural tube defects. Therefore, it is important to get enough folic acid through eating a healthy diet with food that has been fortified with folic acid, by taking a folic acid supplement, or a combination of both.
To help prevent neural tube defects in your baby, you should take a vitamin supplement with at least 400 mcg of folic acid every day before you get pregnant. Ideally, you should start taking it at least one month before pregnancy and continue it through the first 12 weeks of pregnancy. The supplement can be a multivitamin, a prenatal vitamin, or a supplement that just contains folic acid.
There are many foods that are a good source of folic acid and safe to eat in pregnancy:
Dark green leafy vegetables (turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli)
Fresh fruits, fruit juices
Fortified foods include bread, cereal, rice, flour
Making these foods part of your diet in pregnancy will not only help to decrease your risk of neural tube defects but can also help you gain a healthy amount of weight during your pregnancy and decrease the risk of anemia, since many of the foods are also rich in iron and vitamin C.
Some people are at a higher risk of having neural tube defects. This includes people who have had a previous pregnancy or child affected by a neural tube defect or a partner with a child who has a neural tube defect, people who have a neural tube defect themselves or a partner with a neural tube defect, and people who have a seizure disorder called epilepsy and are taking anti-seizure medication. If you’re at high risk for having a baby with a neural tube defect, then it is recommended that you take at least 4 mg or 4,000 mcg of folic acid each day to help decrease the risk of a neural tube defect. Ideally, we recommend starting the high dose of folic acid at least 3 months before becoming pregnant through 12 weeks of pregnancy.
If you are at a higher risk, talk with your provider regarding how to safely get the high dose of folic acid. It’s not safe to take several multivitamins or prenatal vitamins because you can get too many other nutrients, which can be harmful. Your provider can help you figure out the best and safest way for you to get the right amount of folic acid.
Folic acid is an easy, low-cost intervention that could potentially have life-saving benefits for babies. Let’s all do our part to help prevent neural tube defects by making sure that all people know about the potential benefits of getting enough folic acid long before they have a positive pregnancy test!
Kara L. Malone, MD is a board-certified obstetrician and gynecologist at The Ohio State University. She joined Nationwide Children’s Hospital as medical director of the Teen and Pregnant (TaP) Program in 2015. Her clinical interests include the care of pregnant adolescents and providing culturally sensitive care to minorities, including the LGBTQAI population.
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