Frequently Asked Questions
Who should take folic acid?
How much folic acid should women and young girls take?
How much folic acid is in fortified foods?
How does folic acid prevent birth defects?
Are there other benefits of folic acid supplementation other than the prevention of birth defects?
Are there any side effects from taking folic acid supplementation?
Will folic acid supplementation harm my baby if I take it during pregnancy?
Should I simply take extra tables of my multivitamin/prenatal vitamin in order to get enough folic
acid?
How much does folic acid cost?
Should men take folic acid supplementation?
Is anyone conducting research on folic acid?
I’ve already had a child with spina bifida. Does this mean anything different for me?
My daughter is not sexually active, but she is in the suggested age range for using folic acid. What
should we do?
Is there anything else (besides folic acid) that I can to do to improve my chances of having a healthy
baby?
I understand the importance of folic acid. How do I convince others that I care about?
Who should take folic acid?
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All women 10 -50
Mention that 70% preg ‘unplanned’
How much folic acid should women take?
According to the U.S. Public Health Service, U.S. Preventative Services Task Force, March of Dimes, the
Institute of Medicine, the American College of Obstetricians and Gynecologists (ACOG), and the Centers
for Disease Control and Prevention (CDC), all women of childbearing age in the United States who are
capable of becoming pregnant should consume 0.4 mg (400 mcg) of folic acid per day for the purpose of
reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects (NTDs).
Most prenatal supplements contain between 0.4mg and 0.8mg of folic acid and either is considered safe
and acceptable for women planning to become pregnant or who are pregnant. In addition, women
should eat a healthy diet including foods rich in folic acid. This is the only sure way a woman can get all
the folic acid and other vitamins she needs. Most women get only about 200 micrograms of folic acid a
day from their diets.
The body can absorb almost 100 percent of the synthetic form of folic acid. This is why it is
recommended that women who could become pregnant consume 400 micrograms a day of the
synthetic form.
However, women should not take more than 1,000 micrograms (mcg) (or 1 milligram (mg)) without their
doctor's advice.
How much folic acid is in fortified foods?
As of January 1, 1998, the U.S. Food and Drug Administration has required the addition of 140
micrograms (mcg)of folic acid per 100 grams of grain product to cereals, breads, pastas, and other foods
labeled "enriched." (Several cereals contain the recommended daily amount of 400 micrograms (mcg)
per serving, but most contain from 25 to 50 percent.) This makes it a little easier for women to obtain
folic acid from their diets link to page 6. Currently most women do not obtain enough folic acid from
their diet alone. In fact, it is extremely difficult for a person to get enough folic acid by diet alone.
Eating habits will need to change to select enriched foods with higher fortification levels and to include
fruits and vegetables - which is also heart healthy. Because some fortified breakfast cereals contain 400
micrograms of folic acid in one bowl, a woman could get the recommended amount of synthetic folic
acid this way, or she can take a multivitamin. The FDA did not require that more folic acid be added to
enriched foods because of the concern that folic acid might mask one sign of a potentially dangerous
condition called pernicious anemia, that is seen mainly in elderly people. The level of fortification the
FDA currently requires is believed to be safe for everyone.
How does folic acid prevent birth defects?
How folic acid prevents NTDs is not well understood. Some studies suggest that it may correct a
nutritional deficiency, while others suggest that supplemental folic acid helps compensate for errors in
how the body processes folic acid.
For example, a recent study found that as many as one in seven people may carry a genetic mutation
(change) that causes them to have a deficiency in folic acid, even if they are consuming a diet that
contains the recommended amount of folic acid. These people have problems breaking down folic acid
found in food to forms of folic acid the body can use, resulting in lower folic acid levels in the blood.
Studies suggest that women with this gene mutation may be at increased risk of having a baby with a
neural tube defect (NTD). However, taking synthetic folic acid either by pill or fortified food appears to
raise levels of the vitamin in the blood, and thereby reduce the risk of having an affected baby.
Are there other benefits of folic acid supplementation other than the prevention of birth defects?
Yes. Folic acid has been shown to contribute to healthy skin, hair and nails. There have also been links
made to potential benefits of folate in some types of cancers (colon and brain) and depression, although
these effects have yet to be proven. Folic acid use for over a year has been shown to reduce the risk of
premature delivery. Recently published studies have also shown that folic acid may reduce the risk of
having a child with autism.
Are there any side effects from taking folic acid supplementation?
Folic acid supplementation appears to be well tolerated at the recommended doses. However, flushing,
fatigue, rash, itching, allergic reactions, etc. have been reported. The risks of higher levels of folic acid
supplementation are believed to be minimal. Folic acid is considered nontoxic even at very high doses
and is rapidly excreted in the urine. However, because the effects of high intakes are not well known
but include complicating the diagnosis of vitamin B-12 deficiency, care should be taken to keep total
folate consumption at less than 1 mg per day, except under the supervision of a physician.
Will folic acid supplementation harm my baby if I take it during pregnancy?
No. There does not appear to be risk to the baby at the recommended doses. In fact, it is recommended
that pregnant women take folic acid supplementation prior to pregnancy and during pregnancy in order
to prevent birth defects such as spina bifida. Women may wish to consult their physicians or other
health-care providers (nutritionists, dietitians) about how to best obtain the recommended amount of
folic acid, while avoiding excessive consumption
Should I simply take extra tables of my multivitamin/prenatal vitamin in order to get enough folic
acid?
No. While you can often achieve the recommended dose of folic acid by taking more than one
multivitamin tablet each day, this is NOT recommended. Since multivitamins and prenatal vitamins
contain many different substances as well as other vitamins, taking higher amounts of these other
vitamins (e.g. Vitamin A) can be harmful to the mother and the baby.
How much does folic acid cost?
Folic acid is very inexpensive! Some over the counter formulations can be less than 1 penny per day for
a one month supply!
Should men take folic acid supplementation?
Yes. It is safe for men and women both take folic acid supplementation (400 mcg daily) in addition to
their healthy diet.
Is anyone conducting research on folic acid?
The March of Dimes has several research grantees who are seeking to improve understanding of how
folic acid prevents NTDS. Because most NTDs are believed to be caused by a combination of genetic and
environmental factors (including nutritional factors like folic acid), other grantees are trying to identify
genes that increase a woman's risk of having a baby with an NTD.
One of these researchers is focusing on 5 genes that play a key role in how the body breaks down food
folates, to see if mutations in any of these genes increase the risk of spina bifida. Another researcher is
looking at how folic acid is transferred from the placenta to the fetus, and trying to identify any factors
that could interfere with this process. These studies could lead to ways to identify women who are at
increased risk of having a baby with an NTD, and to improved ways to treat them, with the goal of
preventing even more NTDs than is currently possible.
The information and resources listed here are intended for educational use only. The information
provided on this web site should not be used for diagnosing or treating a health problem or a disease. It
is not a substitute for professional care. Always contact your physician and/or other qualified healthcare
professional before starting any new treatment or with questions about your health.
I’ve already had a child with spina bifida. Does this mean anything different for me?
If a woman has already had a baby with an NTD, she should consult her doctor before her next
pregnancy about the amount of folic acid she should take. Studies have shown that taking a larger dose
of folic acid daily (4.0 milligrams (mg)), beginning at least one month before pregnancy and in the first
trimester of pregnancy, may reduce the risk of having another affected pregnancy by about 70 percent.
My daughter is not sexually active, but she is in the suggested age range for using folic acid. What
should we do?
Even if a young lady is not sexually active, there are many other good reasons to take folic acid (see the
FAQ above link back to FAQ #5). What is most important is to get the habit of using folic acid started.
That way, down the road, when it is needed, the habit is firmly established.
Is there anything else (besides folic acid) that I can to do to improve my chances of having a healthy
baby?
Yes. There are many things that can be done to improve pregnancy outcomes besides the use of folic
acid. These would include avoiding alcohol, cigarettes and other recreational drugs. Prior to becoming
pregnant a woman can make any desired medication changes with their doctor. Also she can consult
with her doctor regarding weight recommendations and stabilization. Any changes in school or the work
place to avoid unwanted exposures can also be started before getting pregnant. link to page 14
I understand the importance of folic acid. How do I convince others that I care about?
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