• Folic Acid 800 mcg 100%

Folic acid is a B vitamin that can help prevent birth defects of the brain and spinal cord called neural tube defects (NTDs). Folic acid works to prevent these birth defects only if taken before conception and during early pregnancy.

Because NTDs originate in the first month of pregnancy, before many women know they are pregnant, it is important for a woman to have enough folic acid in her system before conception. Folic acid is recommended for all women of childbearing age because about half of all pregnancies in this country are unplanned.

Why should women of childbearing age take folic acid?
Studies show that, if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all NTDs could be prevented.

The neural tube is the embryonic structure that develops into the brain and spinal cord. This structure, which starts out as a tiny ribbon of tissue, normally folds inward to form a tube by the 28th day after conception. When this process goes awry and the neural tube does not close completely, defects in the brain and spinal cord can result. About 2,500 babies are born with NTDs each year, and many other affected pregnancies end in miscarriage or stillbirth.

The most common NTDs are spina bifida and anencephaly. Spina bifida, often called “open spine,” affects the backbone and, sometimes, the spinal cord. Children with the severe form of spina bifida have some degree of leg paralysis and bladder and bowel control problems. Anencephaly is a fatal condition in which a baby is born with a severely underdeveloped brain and skull.

Studies also suggest that folic acid may help prevent some other birth defects, including cleft lip and palate and birth defects involving the heart and limbs.

How much folic acid does a woman need?
The March of Dimes recommends that all women who can become pregnant take a multivitamin that contains 400 micrograms of folic acid every day and eat a healthy diet. This advice, based on recommendations from the Institute of Medicine (IOM), assures that a woman can get all the folic acid and other vitamins she needs. However, a 2003 March of Dimes Gallup survey showed that only 1 in 3 (32 percent) women of childbearing age in the United States take a vitamin with folic acid daily.

The IOM also recommends that women eat a diet rich in foods that contain folate or folic acid. Folate is the natural form of folic acid that is found in foods. Dried beans and legumes, oranges and orange juice, peanuts and leafy green vegetables all contain folate. (Any woman with a history of nut allergies should avoid eating peanuts or peanut products at all times, not just while pregnant or breastfeeding.)  Synthetic (manufactured) folic acid is added to grain products, including flour, rice, pasta, cornmeal, bread and cereals. These foods are considered “fortified” with folic acid.

The body more readily absorbs folic acid from vitamin supplements and fortified foods than folate from food. According to the IOM, about 50 percent of food folate is absorbed by the body, while approximately 85 percent of folic acid in fortified foods and 100 percent of the folic acid in a vitamin supplement are absorbed. Cooking and storage can destroy some of the folate in foods. The body cannot distinguish the origin of the vitamin, however; once in the bloodstream the biological function is the same.

Numerous studies have shown that the synthetic form of folic acid helps prevent NTDs. This is why the Institute of Medicine, the Centers for Disease Control and Prevention (CDC) and the March of Dimes recommend that women who could become pregnant consume 400 micrograms a day of the synthetic form. Women can do so by taking a multivitamin, most of which contain this amount, or by consuming a bowl of cereal that contains 100 percent of the daily value (DV) of folic acid (400 micrograms). About 50 breakfast cereals now contain this amount in one bowl, but others contain only 25 percent of the recommended amount, so it is important to check the label on the box.

Do some women need more folic acid?
A woman may need more folic acid later in pregnancy. The IOM recommends that women increase their intake of folic acid to 600 micrograms a day (from supplements and food sources) once their pregnancy is confirmed. Most doctors recommend a prenatal vitamin that contains at least this amount of folic acid. However, women should not take more than 1,000 micrograms (or 1 milligram) without their doctor’s advice.

If a woman has already had a baby with an NTD, she should consult her doctor before her next pregnancy about the amount of folic acid she should take. Studies have shown that taking a larger dose of folic acid daily (4,000 micrograms or 4 milligrams), beginning at least one month before pregnancy and in the first trimester of pregnancy, reduces by about 70 percent the risk of having another affected pregnancy. 

Women with diabetes, epilepsy and, possibly, obesity also are at increased risk of having a baby with an NTD. Women with these disorders should consult their doctors prior to pregnancy to see whether they should take a larger dose of folic acid.

How does folic acid prevent birth defects?
How folic acid prevents NTDs is not well understood. Most studies suggest that it may correct a nutritional deficiency, while others suggest that supplemental folic acid helps some people compensate for inborn errors in how the body processes folates.

For example, some studies suggest that between 5 and 15 percent of people carry a genetic mutation (change) that causes them to have a deficiency in folic acid, even if they are consuming a diet that contains the recommended amount of folates. These people have problems breaking down folates found in food to forms of folic acid the body can use, resulting in lower folic acid levels in the blood. Several studies have found that these mutations may be more common in parents who have had a child with an NTD and in children with NTDs. Most mothers of affected babies and babies with NTDS do not have these gene mutations. However, because taking folic acid raises the level of the vitamin in the blood, it may help reduce the risk of these birth defects when either mother or baby does have these mutations. A 2000 study also suggests that women with these mutations may have an increased risk of placental problems, such as placental abruption (when the placenta peels away from the wall of the uterus before delivery). This risk may possibly be reduced by taking folic acid throughout pregnancy.

Besides helping to prevent certain birth defects, folic acid plays other important roles during pregnancy. A pregnant woman needs extra folic acid to help her to produce the additional blood cells she needs. Folic acid also is crucial to support the rapid growth of the placenta and fetus. This vitamin is needed to produce new DNA (genetic material) as cells multiply. Without adequate amounts of folic acid, cell division could be impaired, possibly leading to poor growth in the fetus or placenta. One study found that women who were deficient in folic acid were more likely to have a baby who was premature and low-birthweight (less than 5½ pounds). Another recent study also suggests that low levels of folate may be a risk factor for pregnancy-related high blood pressure.

Does folic acid have other health benefits?
In recent years, doctors have come to realize that folic acid is very important for everyone in maintaining health. It has long been known that folic acid plays an important role in the production of normal red blood cells, and that individuals who are deficient in folic acid sometimes develop a form of anemia called megaloblastic anemia (characterized by a reduced number of red blood cells).