Why taking folic acid is important if you're thinking of having a baby

Bringing a new life into the world is so exciting. While you’re looking forward to the day your life changes forever, it’s well worth investing a bit of time before you start tryingto get as healthy as you can. About a quarter of women will fall pregnant in the first month of trying, so being completely ’baby ready’ before you stop contraception will set your mind at ease when you find you’re expecting. 

Read on for more information, or use the quick links below.

 

Why is folic acid so important for me & my baby? 

You’ll probably have heard of folic acid and may know that it can help prevent neural tube defects (NTDs) like spina bifida and anencephalyBut what is it? What does it do? And most importantly when do I need to take it? 

Folic acid, known as folate when it is found in food and being used by the body, is Vitamin B9. It needs to be eaten in food or taken in supplement form. Your body uses it in many different ways, for example to make the DNA for all new cells.  Very low levels of folate in the red blood cells can lead to anaemia and other ill health, such as depression and some cancers. 

We know from research that a much higher level of folate needs to collect inside red blood cells to prevent NTDs than is needed to keep your own body healthy. It takes a little time to build the blood levels, and the most important window for good folate levels is at conception and the first few weeks after. NTDs occur when the neural tube (which develops into the brain and spinal cord) fails to fully close, leaving a gap. This happens around Day 28 after conceiving. Cells are dividing and growing very quickly during this time and need extra folate to make DNA for the new cells.  

Folate deficiency can affect your fertility, so taking a supplement before trying can help you get pregnant if you have stopped using contraception. 

Taking a folic acid supplement can lower the chance of your baby having a low birthweight or being born prematurely (before 37 weeks). 

Did you know?

When taken for eight weeks before conception, and in the early weeks of pregnancy, folic acid can help reduce the chance of babies being born with neural tube defects by around 70%.  

 

If folate is a vitamin, can’t I get enough from food alone? 

No, not realistically. All adults and children over 11 years old should have 200 mcg of folate in their diet each day. Good sources of folate include: 

  • Beans, lentils and peas 
  • Oranges and orange juice 
  • Broccoli, spinach, cabbage, Brussels sprouts, kale. 
  • Yeast & beef extracts 
  • Wheat bran and other wholegrain foods 
  • Fortified foods (some brands of cereal- check the labels) 
  • Poultry, pork, liver and shellfish.      

If you might become pregnant you should take an additional folic acid supplement of 400mcg daily for at least eight weeks before trying to conceive. 

For more information, check out this factsheet, courtesy of the British Dietetic Association.

You may need a higher dose of folic acid (5 mg) if you- 

  • Have a health condition such as diabetes or coeliac disease 
  • Are very overweight (BMI over 30) 
  • Have spina bifida 
  • Have a relative affected by a NTD (or your partner has) 
  • Take certain medication for epilepsy 
  • Have had a pregnancy affected by a NTD  

5 mg supplements are only available on prescription so you will need to speak to your GP.  

Can I get the extra 400mcg through diet?

It's not easy, or particularly exciting trying to consume the extra amount through diet alone, and remember, you need to do it every day. See for yourself what 400mcg looks like by trying to build your plate of food in this great online game, courtesy of the Florida Folic Acid Coalition. 

Play the folic acid game

Our top tips...

  • Microwave or steam your veg and avoid overcooking to stop the folate being lost.
  • Taking your folic acid supplement at the same time every day can make it easier to remember, although it doesn’t have to be taken at the same time every day in order to work 

 

What else can I do to get ready? 

The chance of your baby being affected by an NTD can be lowered. Begin to get ready a few months before you start trying for a baby. 

Make sure you’re at a healthy weight before you start trying. Being overweight will increase your chances of your baby having a NTD, as well as other pregnancy and birth problems. If you’re overweight and already pregnant, talk to your midwife about how to manage your weight safely through healthy eating 

You can check your BMI here, using Tommy's online calculator

Being very overweight can make the likelihood of your baby having an NTD four times higher than having a healthy weight.  By ‘very overweight’ we mean a body mass index (BMI) over 30: for example, over 12.5 stones for a woman of 5’4”. This can also put you and your baby at risk of other serious complications, like prematurity. 

Try to exercise regularly with at least 150 minutes of moderate activity each week. 

Don’t smoke, and drink alcohol in moderation. If you drink a lot of alcohol or drink most days, you are more likely to be deficient in folate. If you are pregnant, the safest approach is to not drink alcohol at all. 

For further information on preparing for pregnancy, visit: 

 www.shinecharity.org.uk/spina-bifida/lowering-the-chances  

And 

https://www.shinecharity.org.uk/spina-bifida/folic-acid 

 Tommy’s Charity have developed this great planning tool, to help you prepare for pregnancy: www.tommys.org/pregnancy-information/planning-pregnancy/planning-for-pregnancy-tool 

https://www.nhs.uk/conditions/pregnancy-and-baby/planning-pregnancy/

Vitamin B12 

Vitamin B12 works closely with folate and can also lower the chances of spina bifida or anencephaly. Everyone needs Vitamin B12 in their diet and can consume it in meat, fish, eggs, cheese and some fortified breakfast cereals. Most people should be able to get enough through their diet, however, vegetarians and vegans may need to take extra Vitamin B12 to get enough. Shine recommends that if you are trying to conceive, you should take a 2.5 mcg supplement every day for three months before you start trying if you’re thinking of having a baby. 

If you have a stomach condition, have had surgery to your stomach or take medication for excess stomach acids, or a family history of pernicious anaemia, ask your GP to check the level of vitamin B12 in your blood before you begin to try for a baby. If you have had weight-loss surgery to staple your stomach or intestine you should take advice well in advance of trying to conceive. Vitamin B12 is only absorbed from food a little at a time. 

Inositol 

Inositol may possibly lower the chances of NTDs according to one small study. Further research is needed to see how well it works. 

High temperatures 

If you develop a high temperature, for example from flu, or a urine infection, use contraception again for that month. Don’t try for a baby until you’re completely better. 

If you have a urine infection and are prescribed trimethoprim, do tell your GP if you might be pregnant or are planning to try soon, as trimethoprim blocks the action of folate and is associated with NTDs. Your GP may prescribe an alternative antibiotic. If trimethoprim is prescribed, use contraception for another month or two. 

If you need any more information, please contact Shine’s Health Team, who will be glad to talk you through the preparations for your pregnancy. 

What if I am already pregnant? 

Folic acid should be taken daily up until the 12th week of pregnancy. If you have learned that you are pregnant and haven’t been taking folic acid, consult your GP as soon as you can, and they will advise whether you should start taking folic acid.  

What are the other benefits of folic acid?  

Folate/folic acid is essential in many of the body’s processes. It supports the brain and nerves, good mental health, the cardiovascular system and the immune system, and because it helps make DNA, all cells can benefit. 

I’ve heard that folic acid causes autism, is this true? 

There is no evidence that taking folic acid until the 12th week of pregnancy increases the chance of your baby having autism.

large analysis of multiple research studies (meta-analysis) across 10 countries has shown that prenatal folic acid supplementation is associated with a 58% decrease in the risk of autism.  

A review on the risks of over-supplementation (consuming more that 1000mcg per day, supplementation throughout pregnancy) suggests there may be some association with ASD and concluded that “caution regarding over supplementing is warranted”.  

To ensure optimum folate levels, your diet should contain the recommended daily allowance of 200 mcg of folate and from 8 weeks before until 12 weeks after conception you should also take a daily 400 mcg tablet. Beyond this time, you should be guided by your antenatal team. 

Shine advises taking 400 mcg of folic acid daily from eight weeks before conception until the 12th week of pregnancy.  

 

 
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