Folate and Folic Acid – What Pregnant and Breastfeeding Women Need to Know
Folate and folic acid play a vital role in embryo development, healthy pregnancies, and infant survival rates. Up to 50% or more of neural tube defects could be prevented with proper folic acid supplementation prior to conception, reports The American Academy of Pediatrics. Read more about this important micronutrient for women of childbearing age and learn the recommended daily intake as well as foods that provide folate.
Understanding Neural Tube Defects and Spina Bifida
Neural tube defects (NTDs) are a major cause of death and disability for fetuses and infants worldwide. An estimated 4,000 pregnancies are affected with NTDs each year with more than one third of these pregnancies spontaneously lost or electively terminated. But what is a neural tube defect? The U.S. National Library of Medicine explains:
“Neural tube defects (NTDs) occur when the neural tube fails to close early in embryonic development, resulting in damage to the exposed underlying neural tissue. These birth defects can result in significant morbidity and mortality depending on the location and severity of the lesion. The most severe―anencephaly―is incompatible with life; the lower lesions observed with spina bifida cause a range of morbidities, including urinary and fecal incontinence and paralysis of the lower limbs.”
Spina bifida occurs when the spine and spinal cord don’t form properly. Children born with severe spina bifida have visible sacs of fluid protruding from their spinal cord. This life-threatening condition opens a child up to infections and life-long complications.
Why All Women (Not Just Pregnant Women) Should Take Folic Acid
The neural tube forms very early in a pregnancy, with The Mayo Clinic reporting that the neural tube forms and closes by the 28th day after conception. Since 49% of pregnancies in the United States are unplanned (according to a 2006 study by the CDC) there is a significant chance that many women are unaware of their pregnancy until after the neural tube forms. Because of this, health agencies advocate for all women of childbearing age to take folic acid.
In 1998, in an effort to lower neural tube defects in general populations across the United States, the U.S. Food and Drug Administration implemented a mandatory fortification of folic acid in grain products. Since then studies have shown that neural tube defects have decreased by 19%-32%.
Is Folate Different from Folic Acid?
Both folate and folic acid are a type of Vitamin B-9 and the two terms are often used interchangeably. The difference is that folate is found naturally in foods while folic acid is a synthetic supplement added to fortified foods.
Daily Recommended Intake of Folate for Women, Pregnant Women and Lactating Women
The National Institutes of Health outlines recommended daily folate intake in micrograms (mcg):
- Non-Pregnant Female (age 19-70): 400 micrograms
- Pregnant Female: 600 micrograms
- Lactating Female: 500 micrograms
Women who are actively trying to conceive should begin upping their daily folic acid intake to prepare for the early days of pregnancy. The Center for Disease Control recommends women with a prior history of NTD-affected pregnancies should consult with their health care provider prior to becoming pregnant and discuss the 1991 U.S. Public Health Service guideline. This calls for women with a past history of NTD pregnancies to take 4 milligrams (or 4000 micrograms) of folic acid beginning the month before pregnancy and continuing through the first trimester. This high amount of folic acid is recommended to prevent NTD but should not be taken without consulting a physician.
What Foods Provide Folate or Folic Acid?
- Vegetables: Spinach, asparagus, Brussels sprouts, lettuce, avocados and broccoli
- Legumes, Beans and Peas: Black-eyed peas, chickpeas, green peas, kidney beans, and peanuts
- Grains: Breakfast cereals, white rice, enriched spaghetti, white bread
- Fruits: Oranges, orange juice, papaya, banana, cantaloupe
- Meat and Seafood: Beef liver, crab, Halibut, ground beef, chicken breast
Ask the Expert – Dr. Alex’s Input on Iron
Alejandra Carrasco, M.D. is board certified in Family Medicine and Integrative and Holistic Medicine. She is a certified practitioner by the Institute of Functional Medicine and has spent the last decade studying nutrition, integrative, preventative, and functional medicine. Dr. Alex is the founder of Nourish Medicine, a functional medicine practice in Austin, Texas that blends the best of natural medicine, conventional medicine, and personalized medicine. Her own experiences as a mother of three fuels her passion for helping families address the root cause of ailments rather than simply masking the symptoms.
Q: Do you recommend synthetic folic acid to your patients?
“In my practice, I recommend that my patients avoid synthetic folic acid and find a prenatal vitamin with L-5-methyltetrahydrofolate. This is the biologically active form of folate which is used at the cellular level for DNA synthesis and repair.”
Q: What are the benefits of folate for breastfeeding women?
“Studies have shown that the levels of folate are maintained in breastmilk at the expense of the mother. So, it’s easy to become depleted. For a nursing mother, folate is essential because it plays an important role in her synthesis and repair of her DNA.”
Q: Do you have any specific recommendations for the best multivitamin or prenatal vitamin on the market that meets folate requirements?
“I always recommend that my patients choose a pharmaceutical grade prenatal vitamin that delivers folate as L-5-methyltetrahydrofolate. My favorite brands are Pure Encapsulations, Designs for Health, Xymogen, Seeking Health, and Integrative Therapeutics.”
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