Dive into the science, benefits, and practical tips for incorporating folic acid into your daily life.

Folic acid is the synthetic form of folate (vitamin B-9), essential for the cell regeneration occurring daily. During pregnancy, the body is supplying nutrients for itself as well as for the fetus which requires increased stores for red blood cell production (aka erythropoiesis). Red blood cells carry oxygen in the body, as well as remove carbon dioxide from the body, so without adequate stores, optimal organism functioning is inhibited.

In its natural form, folate is found in several food sources including avocado and kidney beans, whereas folic acid is generally available in supplement form. As a means of preventing folate deficiency in the U.S., several food products and in particular certain breads and flours have been fortified with folic acid [1]. Folic acid consumption of at least 400mg is recommended for healthy pregnancies as it has been shown to dramatically reduce the baby’s risk for neural tube defects.

The Science Behind Folic Acid

Because of food fortification, folate deficiency is rare in the United States, but supplementation is still recommended to assure appropriate consumption since it is so vital for fetal development [2]. One of the first body parts to develop is the spinal cord and, in the case of a folate deficiency, spina bifida, a birth defect occurring when the spine and spinal cord do not develop normally, in the fetus can result. The neural tube in healthy embryos, forms within 28 days after conception, with improper formation ranging from mild to severe depending on the type, size and location in the body. Keep in mind that only people who are actively tracking signs of pregnancy may know their pregnant within this time from, meaning that many people may not know they are pregnant—and therefore not realize they are folate deficient—until it’s too late [3].

Aside from preventing birth defects, folate and folic acid can support immune function and improve glycemic (blood sugar) control. Folic acid works in conjunction with vitamin B12 and vitamin C to help the body break down, use, and create new proteins which is vital for various metabolic processes [4].

Insufficient folic acid may also increase the risk of cancer, emphasizing the importance of maintaining proper folic acid levels. Additionally, folic acid is used for preventing and treating low blood levels of folate (folate deficiency) and high blood levels of homocysteine (hyperhomocysteinemia) which can put people at risk for blood clots, heart attacks, and osteoporosis [5].

Recommendations

The CDC recommends 400 to 800 micrograms (mcg) of folic acid daily for anyone of childbearing age.

Folate can be found naturally in some food items like broccoli, brussel sprouts, leafy green vegetables like kale, peas, chickpeas and kidney beans. Consuming a diet high in fruits, vegetables and whole grains should satisfy folate requirements, however additional supplementation for child-bearing aged females is a mode of assuring this recommendation. That said, it’s important to note that when taking supplements, more is not better, so focus first on whole foods, then supplement with vitamins or fortified foods [6].

Prenatal vitamins often contain the recommended amount of folic acid; consult a healthcare provider before starting supplements, and beyond pregnancy, folic acid supports overall health, including red blood cell production and the prevention of certain types of anemia.

As often is the case with our micronutrient needs, no one vitamin or mineral will ever act alone, so consider the following for a healthy pregnancy (most of these will benefit you even if you’re not pregnant):

• Drinking plenty of water throughout pregnancy supports healthy amniotic fluid levels and overall hydration.
• Adequate iron intake is essential during pregnancy for the production of red blood cells and the baby’s growth.
• Calcium is vital for bone health and fetal development; include dairy, leafy greens, and fortified foods in the diet.
• Found in fatty fish like salmon and chia seeds, omega-3s support brain and eye development in the fetus.
• Reducing caffeine intake and avoiding alcohol supports a healthy pregnancy.
• Regular prenatal check-ups and consultations with healthcare providers are crucial throughout pregnancy.
• Moderate exercise (with your doctor’s clearance) and adequate rest contribute to a healthy pregnancy.

Meal Planning

Looking to get more folate into your diet? I hope you’ll be happy to learn that there is a wide variety of folate-rich foods. By incorporating these into your daily and weekly meals, you’ll not only meet your required amounts, but you’ll also be hitting up other benefits that we strongly encourage when planning meals: diversity and balance.

Start your day off with this delicious smoothie. Try this mouthwatering chicken salad. Cap off the day with this inventive broccoli pilaf. And check out the list below for even more ideas!

• Spinach and Feta Frittata: Combine eggs, spinach, feta cheese, tomatoes, and herbs for a folic acid-rich breakfast or brunch option.
• Lentil Soup: Prepare a hearty lentil soup with vegetables like carrots, celery, and spinach for a nutrient-dense meal.
• Citrus Quinoa Salad: Mix cooked quinoa with orange segments, mixed greens, avocado, and a citrus vinaigrette for a refreshing and nutritious salad.
• Black Bean Tacos: Fill whole-grain tortillas with black beans, diced tomatoes, lettuce, and salsa for a folic acid-rich, plant-based meal.

If you’re unsure how to get started with meal planning, we got you! Click here to read our most recent article about how to get started with efficient meal planning. Discover the health benefits, money savings, and organizational tips for a nourishing lifestyle in a realistic and sustainable way.

Your Plan for Pregnancy

While the person carrying the baby often takes center stage in discussions about prenatal health, it’s important to remember that the health of the baby begins with all contributors to conception. Research shows that factors like diet, lifestyle, and overall health of the sperm provider play a crucial role in supporting a healthy pregnancy [7]. For example, folate status can influence sperm quality and even impact the baby’s long-term health. Similarly, lifestyle choices like not smoking, managing stress, and maintaining a balanced diet rich in vitamins and minerals are just as important. A healthy foundation from everyone involved gives your little one the best possible start—teamwork really does make the dream work!

If you are of childbearing age or in the early stages of pregnancy:

• Remember to schedule your regular OBGYN visits
• Take your prenatal vitamins (if pregnant)
• Consume a diet rich in fruits, vegetables and whole grains
• Schedule an appointment with a Registered Dietitian (like me!) to help choreograph a healthy diet before, during, and after pregnancy

Insights from a Genetic Counselor

We are never short of resources for you, regardless of the topic. Interested in learning more about the importance of folate status during pregnancy? Click here to watch a replay of an Instagram Live with Genetic Counselor Shira Plonka.

References:

1. Food fortification. (n.d.). Www.who.int. https://www.who.int/health-topics/food-fortification
2. Greenberg, J. A., Bell, S. J., Guan, Y., & Yu, Y.-H. (2011). Folic Acid Supplementation and pregnancy: More than Just Neural Tube Defect Prevention. Reviews in Obstetrics & Gynecology, 4(2), 52–59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/
3. ‌Watson, K., & Angelotta, C. (2022). The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States. Perspectives on Sexual and Reproductive Health, 54(2). https://doi.org/10.1363/psrh.12192
4. ‌Asbaghi, O., Ashtary-Larky, D., Bagheri, R., Moosavian, S. P., Olyaei, H. P., Nazarian, B., Rezaei Kelishadi, M., Wong, A., Candow, D. G., Dutheil, F., Suzuki, K., & Alavi Naeini, A. (2021). Folic Acid Supplementation Improves Glycemic Control for Diabetes Prevention and Management: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Nutrients, 13(7), 2355. https://doi.org/10.3390/nu13072355
5. ‌Cleveland Clinic. (2021, May 7). Homocysteine: Levels, Tests, High Homocysteine Levels. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21527-homocysteine
6. ‌Patel, K. R., & Sobczyńska-Malefora, A. (2017). The adverse effects of an excessive folic acid intake. European Journal of Clinical Nutrition, 71(2), 159–163. https://doi.org/10.1038/ejcn.2016.194
7. Moss, J. L., & Harris, K. M. (2014). Impact of maternal and paternal preconception health on birth outcomes using prospective couples’ data in Add Health. Archives of Gynecology and Obstetrics, 291(2), 287–298. https://doi.org/10.1007/s00404-014-3521-0