Learn about what folic acid is and its role before and during pregnancy.

Chances are, if you’ve done some reading about fertility and pregnancy, you’ve come across folic acid. If you’re still unsure what it is, and why you should take it, keep reading to find out all about this vitamin and its role before and during pregnancy. We’ll explain everything from its different forms to how it helps to boost fertility and prevent birth defects.

What is folic acid?

Folic acid is a manufactured form of vitamin B9, which is an essential micronutrient that the body does not produce on its own. Vitamin B9 is crucial to several dimensions of health, including DNA replication, formation of red blood cells and general development and functioning of the body’s cells. In order to get B9, it must be ingested through dietary or supplement sources. While folic acid is the supplement form of vitamin B9, folate is the name of the form that naturally occurs in food.

Folic acid is either sold on its own, or added to foods or vitamin formulations. It’s worthy of note that folic acid is better absorbed by the body than is folate, which is why it is often recommended to eat foods that have been fortified with folic acid and/or to take folic acid supplements. As we will explain further, this is especially important for women who are or might become pregnant, in order to prevent a category of birth defects known as neural tube defects.

Outside of the context of pregnancy, it is possible for most people to get enough of this vitamin if they eat a balanced diet. Food sources of folate include:

  • Fresh fruit
  • Green leafy vegetables, such as spinach, romaine lettuce, broccoli and brussels sprouts
  • Cereals and whole grains
  • Beans
  • Eggs
  • Liver
  • Seafood

Whereas folic acid is often found in:

  • Manufactured orange juice, breakfast cereals, breads, pasta and rice
  • Folic acid supplements
  • Multivitamins, including fertility supplements and prenatal vitamins

It should be noted that not all countries fortify foods with folic acid. However, this practice is mandatory in the USA, Canada, and Chile, and has been voluntarily adopted in many other countries, including Germany and Switzerland.

Connections between folic acid and fertility

Folic acid has been studied in terms of its effects on fertility in both sexes. Where male fertility is concerned, some individual studies and reviews have pointed to a role for folic acid in improving sperm count and quality. However, a recent randomised clinical trial found that supplementation of folic acid did not result in either a significant improvement in semen quality or a significant increase in live birth rates for couples undergoing fertility treatment.

Similarly, a study of women with unexplained infertility undergoing in vitro fertilisation (IVF) found that supplementation of folic acid, as well as sufficient levels of folate in the blood, did not lead to improved outcomes after the IVF procedure.

However, folic acid may impact female fertility via the ovaries. A 2008 study found folic acid to be important in helping to reduce the risk of ovulatory infertility (in which women cannot conceive due to anovulation, or lack of ovulation). A subsequent study confirmed the association between consumption of folic acid and lower risk of anovulation.

The importance of folic acid in pregnancy

In pregnant women and their unborn children, adequate folic acid helps to prevent a category of birth defects known as neural tube defects (NTDs). NTDS occur when part of the developing brain and spinal cord—referred to as the neural tube at a certain stage of prenatal development—fail to form and close properly while the embryo is developing.

Examples of NTDs are anencephaly, in which parts of the brain and skull are missing, and spina bifida, in which the spine does not close properly, causing various complications, such as weakness or paralysis of the arms and legs. These vary in severity: anencephaly is so severe that the unborn baby will not be able to survive, whereas spina bifida can cause disability without being fatal. All pregnancies can potentially be affected by NTDs, but there are factors—such as maternal obesity or diabetes—that increase the risk.

The relationship between folic acid and NTDs was first hypothesised in the 1960s, but the first randomised controlled trial demonstrating the connection was published in 1991. Carried out at 33 centres in seven countries, this study focused on women who were at high risk for having a baby with NTDs. It determined that taking folic acid before conception reduced the occurrence.

Women who are actively planning pregnancy or trying to conceive should ensure adequate intake of folic acid, ideally starting at least one month before pregnancy. This is because the critical period for NTDs to occur is while the neural tube develops and before it closes, which happens only 28 days after conception. It also takes time for the body to build up adequate stores of folic acid. It is also often recommended that sexually active women in their reproductive years take folic acid daily, as it is possible for unplanned pregnancy to occur.

How much folic acid or folate do I need?

According to European guidelines, adults are recommended to have an intake of 250 micrograms (mcg) of folic acid daily. However, this amount is increased to 400 mcg in women of childbearing age who are planning to get pregnant.

Among pregnant and breastfeeding women, folic acid requirements are further increased, and 600 mcg per day is recommended. A higher dose is also recommended for people who regularly consume alcohol, because this can impair the absorption of folic acid.

What happens when someone doesn’t get enough folic acid?

Since vitamin B9 plays an essential part in maintaining healthy development and functioning, an absence of it can lead to serious medical conditions.

Conditions that are associated with a lack of folic acid include:

How common is it not to get enough?

The medical community draws a distinction between folate deficiency, which can lead to health problems such as anemia (an insufficient number of healthy red blood cells), and folate insufficiency, which is a level at which neural tube defects are still a risk. It is estimated that, especially in lower-income countries, more than 20% of women of reproductive age may be folate deficient, and more than 40% may have folate insufficiency. However, a recent study conducted in Switzerland found that around 20% of non-pregnant women of reproductive age had folate deficiency, and a much higher percentage (92% of women of reproductive age and 52% of pregnant women) had folate insufficiency.

Commonly-asked questions

Can folic acid help me to get pregnant?

The main reason that women trying to get pregnant should ensure adequate folic acid is to promote healthy fetal development and prevent birth defects. However, the research also shows that folic acid can be helpful for women who are not ovulating.

Do folic acid supplements have side effects?

Certain mild side effects are reported, such as nausea, loss of appetite, and bloating.

Is it possible to get too much folic acid?

The upper limit for folic acid intake is 1,000 mcg per day. Though harmful effects to the body’s organs (known as toxicity) from folic acid is rare, too much of this vitamin can mask a vitamin B12 deficiency, which can have serious consequences, including neurological damage.

How long should I take folic acid before getting pregnant?

It is often recommended that women start taking 400 mcg of folic acid at least one month before getting pregnant. However, some research has suggested that this is not sufficient, and that either a longer timeframe or a higher dose would be needed. Your doctor can offer advice based on your particular situation.

What other supplements should I think about if I want to get pregnant?

It’s a good idea to ask your doctor what is appropriate for you. However, there is good evidence regarding adequate intake (from foods and/or supplements) of nutrients such as vitamin D and selenium.

Takeaway

Folate and folic acid are naturally-occurring and supplement forms, respectively, of Vitamin B9, which is essential to formation of new cells in the body. Getting enough folic acid helps to promote ovulation in women, as well as to prevent neural tube defects during pregnancy. It is recommended that women begin taking folic acid supplements at least one month before pregnancy. Men and women not considering pregnancy should also ensure adequate intake of folic acid. As with all supplements, it is a good idea to consult with a doctor for personalised advice.

Do you need more guidance, or wish to discuss this in person? Cada’s caring fertility specialists will be happy to meet you and start creating your personalised plan. Secure your spot for a free consultation today!