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Folic Acid: A "Family Values" Vitamin

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Preventing Birth Defects | Getting a Pre-pregnancy Exam | Becoming More Aware | Getting the Recommended Amounts

Folic acid, also called folate, is a B vitamin, essential for the division of all body cells and the production of DNA and RNA, the genetic material of life. Without it, nothing can grow—not even a single hair or fingernail—and healing cannot take place. Folic acid is found in orange juice, leafy green vegetables, and beans. The US Food and Drug Administration (FDA) requires folic acid to be added to enriched grains, such as breads, cereals, and pasta.

Preventing Birth Defects

Through its role in the cellular processes required for normal fetal development, folic acid helps prevent neural tube defects (NTDs). Occurring in about one in 1,000 births, NTDs are among the most serious birth defects in the United States. NTDs occur when the neural tube, which forms the brain and spinal cord, fails to close. Folic acid supports the normal fusion of the neural tube.

NTDs include anencephaly and spina bifida. Anencephaly occurs when a large portion of a baby's brain is not fully formed. This condition is incompatible with life. Spina bifida, which occurs when a fetus's spine does not close completely, is the most common NTD. According to the March of Dimes, the risk of NTDs could be reduced by 70% if women consumed an adequate amount of folic acid. Another study suggests that folic acid may prevent 50% of birth defects across the board, including cleft lip and cleft palate.

These statistics are impressive, but there is a catch: Women must consume sufficient levels of folic acid prior to conception since the neural tube is formed very early in pregnancy. Bolstering folic acid status early, about a month prior to starting to try to conceive, ensures that a woman has an adequate amount in her body at conception.

The problem, however, is that nearly half of all pregnancies in the United States are unplanned. Because of this, the March of Dimes and United States Public Health Service have recommended that all women of childbearing age, including all teenage girls, consume 400 mcg (micrograms) of folic acid each day. Most multivitamins contain this amount, as do some fortified breakfast cereals. Other good food sources include beef liver, black eyed peas, spinach, asparagus, and baked beans.

Other countries also fortify their food with folic acid. Canada, for example, has seen signs of benefit with its fortification program—a decrease in the number of babies born with heart defects, suggesting that folic acid can offer protection beyond neural tube defects. Taking folate and iron may offer additional benefits, like reducing the number of infants born with low birth weight and reducing infant mortality.

Getting a Pre-pregnancy Exam

Once a woman finds out that she is pregnant and goes for her first prenatal visit, she will probably be advised to take a prenatal multivitamin that contains folic acid. However, it may be too late to prevent NTDs at that point. It is imperative that a woman and her partner have a pre-pregnancy check-up to explore pregnancy risk factors and determine the need for folic acid supplementation.

Becoming More Aware

Unfortunately, many women are unaware of the recommendations regarding folic acid intake. To help spread the word, one week in January is dedicated as National Folic Acid Awareness Week, a time to spotlight NTD prevention. It's an opportunity to get the word out that some disabling or fatal birth defects are easily preventable.

Getting the Recommended Amounts

Recommended daily allowances and adequate intake levels for folate:

AgeMicrograms (mcg) per day
0-6 months65 mcg
7-12 months80 mcg
1-3 years150 mcg
4-8 years200 mcg
9-13 years300 mcg
14 years and older400 mcg
Pregnant women600 mcg
Nursing women500 mcg

Here are the tolerable upper intake levels for folic acid from fortified foods or supplements:

AgeMicrograms (mcg) per day
1-3 years300 mcg
4-8 years400 mcg
9-13 years600 mcg
14-18 years800 mcg
Pregnant or nursing women up to 18 years800 mcg
19 years or older1000 mcg
Pregnant or nursing women 19 years and older1000 mcg

Centers for Disease Control



Women's Health Matters



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11/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Christian P, Stewart CP, LeClerq SC, et al. Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial. Am J Epidemiol. 2009;170:1127-1136.

Last reviewed June 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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