The importance of folate AKA vitamin B9 or folic acid before and during pregnancy

Folate is naturally found in many foods, also known as vitamin B9.

Folic acid is used in supplements and in fortified/enriched foods to help meet the recommended daily amount.

Folate/folicacid is essential for cell division and the synthesis of DNA in the body. Without folate, living cells cannot divide.

One of the most important functions is to promote growth. Folate/folic acid is even more potent growth promoter than vitamin B12 and, like vitamin B12, is important for the maturation of red blood cells (RBC).

Great sources of folate

  1. Chicken liver
    One contains around 254 mcg of folate
  2. Cooked Lentils
    180 mcg of folate in half cup
  3. Great Northern Beans
    90 mcg of folate in half cup
  4. Chickpeas (Garbanzo Beans)
    71 mcg of folate in half cup
  5. Dark green leafy vegetables
    Like spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli.
    50 mcg of folate in half cup
  6. Avocados
    40 mcg of folate in half cup
  7. Citrus fruits and juices
    One orange contains between 40 and 50 mcg of folate.

Nonetheless, four large servings of the above per day would barely remedy a minor deficiency during pregnancy. So, combine food sources with supplemental folic acid, about 2,400 mcg daily.

Good sources of Folic acid

  • Enriched Breads and Pasta, one serving of enriched wheat spaghetti contains around 100 mcg of folic acid.
  • Fortified Cereals, one cup serving contains between 100 to 400 mcg of folic acid.

When to start taking Folic acid?

If you are a woman in a childbearing age (ages between 12 and 51) or from first menstruation to the end of menstruation. This is like all the time!

But most important time is when you start getting ready for pregnancy, it’s when you need that baby to grow strong and healthy, remember neural tube defects may develop in the first 28 days of pregnancy, this may be before she even realize that she is pregnant.

Risks Of Not Taking Folic Acid?

>> Neural tube defects in baby
– Spina bifida
– Anencephaly
– Meningomyelocele
– Encephalocele

>> Cleft palate and harelip

>> Cardiac defects

>> Having folic acid deficiency (macrocytic or megaloblastic anemia – large cells) due to:
– Increased demand as seen in pregnancy or infancy.
– Inadequate intake as seen in alcoholics or in elders.
– Malabsorption syndromes may also produce folic acid deficiency.

Diagnosis of folic acid deficiency

In a complete blood count (CBC)
– Elevated mean corpuscular volume (MCV), which indicates the average size of red blood cells (RBC) are high.
– Normal mean corpuscular hemoglobin (MCH), which indicates the average amount of hemoglobin per cell.

This often can be treated effectively with folic acid alone.


1. For women of childbearing age:
0.4 mg (400 mcg) folic acid/day
Meeting this recommended daily amount of folic acid is crucial even before pregnancy as most neural tube defects form within the first 28 days after conception, before most women even realize they are pregnant.

2. For women of childbearing age plus
– Had an infant with neural tube defect
– Have a seizure disorder
– Has insulin dependent diabetes
Higher dose is needed: 4 mg folic acid/day starting 1 month before trying to become pregnant (prior to conception) and during the first 6 to 8 weeks of pregnancy.

Folic acid drug interactions
– Some anticonvulsants: phenytoin, carbamazepine, valproic acid, and phenobarbital.

Note: Pre-conceptional folic acid levels in some women with epilepsy may then cause fetal malformations, these drugs may cause folic acid deficiency.

-Methotrexate: action is inhibited by folic acid.
– Oral contraceptives: increase risk of folic acid deficiency.
– Corticosteroids: increase folic acid requirements.
– Sulfonamides: decrease absorption of folic acid.

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