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Folate and Folic Acid Before, During, and After Pregnancy

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What is Folate or Folic Acid?

Folate and folic acid are (almost) the same thing. Folate is a B vitamin (B9) found naturally in foods. Folic acid is the synthetic (man-made) form of folate that you find in fortified foods and vitamin supplements. In Canada, folic acid is added to white flour, enriched pasta and enriched cornmeal. Other foods that may contain added folic acid include breads, buns, cookies, crackers, pasta, and ready-to-eat cereals. Folate and folic acid share the same function in the body, so you can get your daily requirement either naturally or via fortified foods and supplements without needing to worry that one is superior to the other.

Why Should Women Take Folate and Folic Acid Before, During and After Pregnancy?

Folate and folic acid is used by the body to make healthy blood cells to cell to help you and your baby grow. It is an extremely important B vitamin during the first four weeks of pregnancy to ensure that the baby’s spine, brain, and skull develop normally. Inadequate intake of folate and folic acid leads to an increased risk of the baby developing neural tube defects (NTDs), which in severe cases can lead to stillbirth or early infant death postpartum.

The Spina Bifida and Hydrocephalus Association of BC reports that 1 in every 750 children born each year in Canada are born with a NTD. The most common type of NTD is spina bifida, a condition where the baby is born with paralysis in one or more of their muscles (in the legs, bladder, and/or bowel). Babies born with spin bifida will require medical care their entire lives as the condition is irreversible.

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The reason why Health Canada recommends that all women who can become pregnant  take daily multivitamin with 400 micrograms (may also be written as “mcg” or with the symbol μg or as 0.4 mg) of folic acid in it is because some women may not realize they are pregnant until after they’ve missed their period for one to two weeks. Since NTDs occur in the third and fourth week after conception, it’s highly possible that a pregnant woman (without knowing they were pregnant) did not take enough folate in their diet to meet the increased demands of their developing baby and as such, increased their risk of NTDs. Therefore, despite widespread folic acid fortification in common food products in Canada, it is still suggested that women of childbearing age (14 to 50 years old) take 400 mcg of folic acid per day on top of any folate they’re getting through food.

Some women are at a higher risk of having a baby with a NTD. This applies to women who:

  • have a family member with a NTD
  • have a medical history of diabetes, obesity or epilepsy
  • have already had a baby with a NTD or a pregnancy affected by a NTD

Women who fall under this category of increased risk should talk to their doctor or midwife to discuss whether a higher dosage of folic acid supplementation is necessary.

How Much Folate Does a Woman Need?

Recommended Dietary Allowance (RDA) for Folate (Daily)
All women
(Age 14 to 50)
400 mcg
Pregnant women 600 mcg
Breastfeeding women 500 mcg

 

Most prenatal multivitamins contain 1000 mcg, which is the upper limit for folic acid supplementation (more details below). Most daily multivitamins contain 400 micrograms (also written as mcg or μg), which is equal to 0.4 milligrams (mg) of folic acid. This is sufficient for women before pregnancy without additional folate taken from the diet. For pregnant and breastfeeding women, continue taking  a multivitamin with 400 mcg folic acid and increase the dosage if you’re not getting enough folate through your diet to meet the recommended amounts of 600 mcg and 500 mcg respectively.

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Do not exceed the daily limit of folic acid of 1000 mcg unless you’ve been advised by a physician to do so. Over-supplementation of folic acid can lead to other health problems. The upper limit of 1000 mcg applies only to supplements and folate fortified foods. According to HealthLinkBC, the amount of folate in enriched foods is given as a percentage of the daily value (DV) and the standard used is 220 mcg. For example, if a serving of cereal has 15% of the daily value, it has 33 mcg of folic acid (0.15 x 220 mcg = 33 mcg). It’s estimated that 100-200 mcg of folic acid is taken daily from fortified foods.

Naturally occurring folate does not have a upper limit as it has not been shown to have adverse effects.

Those who have folate deficiency from malabsorptive conditions such as Celiac Disease or inadequate intake of folate (such as in chronic alcoholism) should speak with a physician about how much folic acid supplementation is appropriate. According to Merck Manual, folate deficiency is usually treated with supplemental 400-1000 mcg of folate daily.

When choosing a multivitamin, choose one that also has vitamin B12, which works with folate to make DNA.

Good Sources of Folate in Foods

Good sources of folate include:

  • beans
  • peas
  • lentils
  • edamame (green soybeans)
  • asparagus
  • avocado
  • spinach
  • broccoli
  • romaine lettuce
  • beets
  • Brussels sprouts
  • green peas
  • gai-lan (sometimes called Chinese kale)
  • bok choy
  • oranges
  • orange juice
  • wheat germ
  • sunflower seeds
  • yeast extract (such as marmite)
  • peanuts
  • liver (do not eat more than 75 grams of liver per week because it is very high in vitamin A. Too much vitamin A can harm your developing baby and cause birth defects and/or liver toxicity.)