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Why Taking Folic Acid Is Essential Before And During Pregnancy

Taking folic acid before and during pregnancy can greatly reduce risk for spinal-cord-related birth defects in your baby. See how much you should be taking.

pregnant woman sitting on the couch looking at a picture of an ultrasound
Updated January 14, 2022

By Harsha Sharma, MD, Obstetrician and Gynecologist
Virtua OB/GYN

If there's a possibility you could get pregnant (and that includes most women in late teens to mid-40s), you should be taking a daily folic acid supplement now. That's because taking folic acid can decrease the risk of neural tube defects in a developing baby by 93% compared to not taking a supplement.

If having a baby isn't in your immediate plans, it may not seem important to take folic acid now. But, to decrease the risk of neural tube defects, you have to supplement with 400 mcg (micrograms) of folic acid for at least one to three months before conception and the entire pregnancy. This ensures you're getting adequate folate during organ formation, which primarily occurs in the first trimester, and later in pregnancy, to meet your needs and the growth and development needs of the fetus.

Few women become pregnant exactly when they've planned—so, in the first prenatal appointment, most women have already missed the critical window for this supplementation.

What is the neural tube?

In a developing fetus, the neural tube is the part that becomes the brain and spine. It closes entirely by the end of the 4th week after conception, which is around the time you'd test positive on a pregnancy test.

Neural tube defects (NTDs) occur when something goes wrong with that closure. Spina bifida is the most common NTD. If the spinal cord doesn't close completely, it can cause weakness, orthopedic abnormalities, or even paralysis of the lower limbs, along with bladder and bowel control issues, sexual function limitations, and many other problems. NTDs also can affect the brain, which is usually a much more serious condition and often fatal.

These defects are scary but also preventable in many instances—and taking folic acid is the best-known prevention method. Other factors that place women at high to moderate risk for NTDs that can be decreased by folic acid supplementation include:

  • Diabetes type 1 and type 2
  • Use of anti-convulsion medications
  • Previous birth to a baby with a neural tube defect
  • A first- or second-degree relative (sibling, parent) with a neural tube defect
  • Maternal gastrointestinal malabsorption

Folic acid sources

Folic acid supplements are available without a prescription at drug stores and should be taken once daily. There also are foods you can include in your diet to give these supplements a boost. However, diet alone will NOT provide enough folic acid to forego the need for a daily supplement.

Many processed carbohydrates have been enriched with folic acid, including bread, breakfast cereals, cornmeal, flour, pasta, and some brands of white rice. Natural sources include beans, leafy greens, asparagus, broccoli, peanuts, and citrus fruits like oranges and grapefruits.

Choose a healthy diet and include some of these foods for good measure. But do yourself (and your future baby) a favor and start a folic acid regimen today. 

Virtua's maternity care program offers many resources, classes, and checklists to help you have a healthy pregnancy.