If you are a woman of child-bearing age, this post is for you. Not just for those who are currently pregnant or breastfeeding. A common misconception is that you don’t need to worry about folate until you are actually pregnant. Not true! Even if you are only at the point of knowing that you want to one day have children, this is something you should be thinking about. January 8 – 14 is Folic Acid Awareness Week and is a great opportunity to talk about this important topic.
What is folate?
Let’s actually back up one step. You may have heard two terms, folate and folic acid. They are often used interchangeably, but are actually two distinct things. The nutrient is folate, also known as vitamin B9, and is the form naturally found in foods. Folic acid, on the other side is the synthetic form found in fortified foods and supplements.
Folate is used for cell growth and reproduction, and is important for all human beings, but especially for those who are in a season of rapid cell growth (pregnancy, nursing and childhood are top of mind).
Why should I take folate?
1. Folate helps prevent neural tube disorders (NTD)
Folate helps build DNA and supports cell growth and reproduction. Basically, the building blocks for life.
Specifically, folate supports neural tube development of your fetus, which eventually grows into the brain and spinal cord. Getting enough folate each day has been shown to prevent major birth defects of the baby’s brain and spine (anencephaly and spina bifida) by 50% to 70%.
In the United States, approximately 3,000 pregnancies are affected by neural tube defects every year. The total lifetime direct cost of care for a child born in the United States with spina bifida is estimated to be $791,900. It’s not a fringe issue.
2. NTD often occur before a woman knows she’s pregnant
This is the biggest case for folate even if you’re not currently pregnant. Sure, your body uses folate every day to stay healthy. But it is especially crucial during pregnancy, as noted above. You may think that it’s ok to wait until you find out that you’re pregnant to start taking folate.
However, since these birth defects occur in the first few weeks of pregnancy, you might not even realize you’re pregnant when folate is needed most. Couple that with the fact that almost 50 percent of pregnancies in the United States are unplanned, and you can see how waiting until you pee on the stick isn’t the best plan of action.
Therefore, if you are a woman of childbearing age, could get pregnant, thinking about getting pregnant, trying to get pregnant, are pregnant or are nursing, you should be taking folate.
3. In this case, food isn’t enough
As a dietitian, this actually pains me to write. But the reality is that relying solely on naturally-occurring folate won’t cut it. Folate is found in a variety of foods such as leafy green vegetables, legumes and beans, oranges and papaya, but 50 to 90 percent of food folate is destroyed in the cooking process.
Yes, you can totally enjoy many fruits and veg raw, but any pregnant woman can tell you that raw veggies don’t always sit well with them, especially in that first trimester. And eating lentils or beans raw just isn’t a thing.
So even if you’re eating a wide variety of healthy foods, you might not be hitting your folate needs daily.
4. Folic acid is more bioavailable than folate
Another point for folic acid in the form of a supplement or fortified foods is that folic acid is more bioavailable than folate. This means that your body is more efficient at using folic acid than folate, can absorb it better and ultimately you get more benefit from it. The exact difference isn’t totally clear, but some research suggests that the bioavailability of folate is about 80% of that of folic acid.
Taking a supplement or enjoying fortified foods every day is important because folate is water soluble and isn’t really stored in the body. Your body needs regular intake to ensure the folic acid is there when it’s needed.
 After posting this, there was a good conversation on Instagram about MTHFR genes, and I wanted to make sure to include some of the information here. If there is any kind of mutation or defect in these MTHFR genes (which effects about 50% of the population on some level), your body won’t metabolize folic acid as well. There is some research that a build-up of unmetabolized folic acid can have negative effects. Therefore, unless you know you don’t have any problems, the recommendation is to find a supplement with methylfolate (another form that is closer to folate found in foods). My recommendations linked below reflect that. For more information on the subject, check out fellow dietitian Melissa Groves’ Instagram post.
5. Folate does more than prevent birth defects
While preventing NTD is a significant reason to regularly take folic acid, there are more benefits to both mom and baby. Some of my pregnant moms think that they can stop taking the folic acid when they reach their second trimester, since the neural tube is already formed by then (not a good idea!).
Folate also enhances red blood cell production. This is super important during pregnancy when anemia (iron deficiency) is a common complaint. Did you know that your blood volume increases by up to 50% when you’re pregnant?! That’s a lot more blood. Folate works with iron and vitamin B12 to support adequate red blood cell count.
Folate also lowers the risk of other pregnancy complications and defects for your baby. Specifically, it can lower the risk of cleft lip and palate, reduce the risk of premature birth, miscarriage, poor in utero growth and low birth weight.
More benefits for mom include helping to precent preeclampsia, heart stroke, heart disease, cancers and Alzheimer’s disease. And finally, everyone’s favorite - stronger, healthier hair and nails! These are rapidly growing cells in your body, and folic acid is key to keeping them healthy.
Ok, I’m convinced. Let’s do this.
Folate needs vary slightly throughout pregnancy:
Preconception and first trimester: 400 mcg / day
Second and third trimester: 600 mcg / day
Breastfeeding / postpartum: 500 mcg / day
Pregnant with multiples: 1000 mcg / day
The most common place that you’ll find folic acid is in fortified breakfast cereals, though you can also find it in many fortified or enriched grain products.
In fact, as a public health campaign, all refined grain products that are sold nationally are required to be fortified with folic acid. I note the “sold nationally” qualifier because if you’re buying bread or tortillas from a local bakery, the requirements don’t hold.
If you’re choosing a fortified cereal or grain product, look at the label to see how much folic acid is in the product. Manufacturers aren’t required to fortify at 100% of the recommended daily value (400 mcg), so your particular cereal may have more or less.
Finally, I strongly recommend a prenatal vitamin or separate folate supplement. I look for one with 600 mcg to support the needs in later pregnancy and postpartum.
There are many brands out there and it can be overwhelming to know what to pick. To make the process a little easier for you, I’ve partnered with Fullscript to share my personal recommendations. You can buy directly from my site if you search for “prenatal” recommendations (click on the image below).