Folic Acid and Pregnancy

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Folic acid—the synthetic form of folate—is a B vitamin that our bodies use to produce new, healthy cells. While folic acid is most commonly recommended for people who are pregnant or attempting to get pregnant to decrease the chances of birth defects, it is an important nutrient that everyone needs.

Pregnant person about to take a pill

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Purpose of Folic Acid

Folic acid—also referred to in various forms as folacin, folate, pteroylglutamic acid, and vitamin B9—assists the human body in the production of new, healthy cells.

Preventing Birth Defects

Getting enough folic acid both before and during pregnancy is important because it can help prevent major birth defects, including anencephaly and spina bifida.

But folic acid isn't only for pregnant people. It's a vitamin that serves an important function for everyone: helping to create red blood cells. Red blood cells are responsible for transporting oxygen all over the body. When a person doesn't make enough red blood cells, it means that their blood isn't able to carry a sufficient amount of oxygen to the rest of their body. This can result in:

  • Fatigue
  • Paleness
  • Weakness

These symptoms are indications of the development of anemia.

Additionally, there are certain parts of the body that are continually growing and regenerating and, as a result, need to make new cells every day. Among these are hair, skin, and nails, so it's not unusual to get a recommendation for the vitamin from your dermatologist to help improve their condition and/or help them grow.

Types of Folic Acid

There are two ways to get folic acid into your body: by eating certain foods or taking supplements.

While some people may be able to get an adequate amount of the nutrient solely by eating a diet rich in foods containing folate (the natural form of folic acid), those who are pregnant or may become pregnant need more so they are typically advised to eat foods rich in folate and take folic acid supplements.

Foods Containing Folate and Folic Acid

There are several different foods you can add to your diet to increase your intake of folic acid. They fall into two categories: foods that naturally contain folate, and foods that have been enriched with folic acid.

For example, folate is found naturally in foods like:

  • Spinach
  • Nuts
  • Beans
  • Beef liver
  • Brussel sprouts
  • Asparagus
  • Orange juice
  • Broccoli
  • Avocado
  • Bananas
  • Papayas
  • Green peas

When a food label indicates that a product has been "enriched with folic acid," it means that folic acid was added during manufacturing—a process called "fortification." (So you may also see labels that say something is "fortified" with folic acid.) Examples of foods that are commonly enriched with folic acid include:

  • Breads
  • Pastas
  • Cereals
  • Rice
  • Flour
  • Cornmeal

Folic Acid Supplements

A pregnant person (or someone who may become pregnant) needs 400 mcg of folic acid each day.

How Much Folic Acid Do You Need?

The Centers for Disease Control and Prevention (CDC) recommends that everyone of reproductive age with a uterus get 400 mcg of the vitamin a day as a way of preventing birth defects, their rationale being that about half of pregnancies are unplanned.

Even if you don't fall into that category, people with a uterus are at a higher risk of becoming anemic during their "reproductive years" than any other demographic, so pregnancy plans or potential aside, a supplement is a good idea.

Even if a pregnant person is making a point to eat as many foods with natural or added folic acid as possible, it's still difficult to get the full 400 mcg through diet alone. That's why the CDC recommends that those who are or may be pregnant take folic acid supplements as well, with the aim being to reach a total of 400 mcg each day.

Keep in mind that many multivitamins contain folic acid already, so check the labels on all of your supplements (in addition to talking to your healthcare provider) to get an idea of the total amount of folic acid you're putting into your body.

Having said that, it's not a case of taking higher doses of folic acid to get increased protection from birth defects. There is currently no evidence that getting more than 400 mcg per day has that effect.

There is one major exception, though. The CDC recommends that anyone who has already had a pregnancy affected by a neural tube defect and is planning to become pregnant again consume 4,000 mcg of folic acid each day one month before becoming pregnant, as well as during the first three months of pregnancy. Those in this situation should discuss any changes in diet or supplements with their healthcare provider first.

Side Effects of Folic Acid

When someone takes folic acid supplements as directed, side effects are uncommon. However, taking doses of folic acid beyond what is recommended—especially more than 1,000 mcg—can result in side effects including:

  • Abdominal cramps
  • Stomach upset
  • Diarrhea
  • Flatulence
  • Taste disturbances
  • Irritability
  • Jitteriness
  • Insomnia
  • Nausea
  • Skin color changes

Otherwise, because folic acid is the synthetic version of folate, people with hypersensitivities may experience side effects including rash, itchiness, and swelling. Go to the emergency room immediately if the reaction also includes shortness of breath, wheezing, rapid heartbeats, dizziness, or swelling of the face, throat, or tongue.

Importance of Folic Acid Before and During Pregnancy

The reason folic acid is so important both before and during pregnancy is because it can help protect a developing fetus against neural tube defects—a category of serious birth defects that affect the:

  • Spine
  • Spinal cord
  • Brain

In some cases, these may cause death.

Neural tube defects occur within the first few weeks of pregnancy—possibly before a person knows they're pregnant. This is why getting 400 mcg of folic acid daily is recommended for anyone with even a chance of becoming pregnant.

The most common neural tube defects are:

  • Spina bifida: The result of when a fetus' spinal column does not fully close in utero, leaving the spinal cord exposed. Following birth, the nerves that control a baby's legs and other organs don't work, often leaving children with spina bifida with lifelong disabilities that require multiple surgeries.
  • Anencephaly: When most or all of the brain and skull do not fully develop in utero. Nearly all pregnancies involving anencephaly result in miscarriage, or the baby dying shortly after birth.

A Word From Verywell

Because of its role in promoting healthy cell growth, it's a good idea for everyone—regardless of age, gender, or reproductive status—to make it a point of incorporating foods naturally rich in folate and those enriched with folic acid into their diet. But people who are or may become pregnant need a little boost in the folic acid department, and that's where supplements come in.

Bring this up with your OB-GYN, if you haven't done so already, to make sure that you're taking the best dose for your needs and conditions. And if the supplements come with better hair, skin, and nails, that's a bonus.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Department of Health and Human Services. Folic acid.

  2. Centers for Disease Control and Prevention. Folic acid: basics.

  3. National Institutes of Health. Folate.

  4. MedlinePlus. Folic acid.

By Elizabeth Yuko, PhD
Elizabeth Yuko, PhD, is a bioethicist and journalist, as well as an adjunct professor of ethics at Dublin City University. She has written for publications including The New York Times, The Washington Post, The Atlantic, Rolling Stone, and more.