Folic acid is a B vitamin. It helps the body make healthy new cells. Everyone needs folic acid. For women who may get pregnant, it is really important. Getting enough folic acid before and during pregnancy can prevent major birth defects of her baby's brain or spine.

Foods with folic acid in them include

• Leafy green vegetables
• Fruits
• Dried beans, peas, and nuts
• Enriched breads, cereals and other grain products

If you don't get enough folic acid from the foods you eat, you can also take it as a dietary supplement.

About folic acid

Folic acid is a B vitamin. Our bodies use it to make new cells. Think about the skin, hair, and nails. These – and other parts of the body – make new cells each day. Folic acid is the synthetic (that is, not generally occurring naturally) form of folate that is used in supplements and in fortified foods such as rice, pasta, bread, and some breakfast cereals.

Are folate and folic acid the same thing?

The terms “folate” and “folic acid” are often used interchangeably, even though they are different. Folate is a general term to describe many different types of vitamin B9.

Types of folate can include

• Folic acid
• Dihydrofolate (DHF)
• Tetrahydrofolate (THF)
• 5, 10-methylenetetrahydrofolate (5, 10-Methylene-THF)
• 5-methyltetrahydrofolate (5-Methyl-THF or 5-MTHF).

Food fortification is a way to add vitamins or minerals, or both, to foods. Some rice, pasta, bread, and breakfast cereals are fortified with folic acid. These foods are labeled “enriched.” Folic acid is a specific type of folate that does not generally occur naturally.

Folic acid is ideal to use for food fortification because it is more heat-stable than types of natural food folate. Heat and light can easily break down types of natural food folate. Folic acid is better suited for food fortification because many fortified products, such as bread and pasta, are cooked.

Women of reproductive age need 400 mcg of folic acid every day

• All women of reproductive age should get 400 mcg of folic acid every day to get enough folic acid to help prevent some birth defects because
  • About half of U.S. pregnancies are unplanned, and
  • Major birth defects of the baby’s brain or spine occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant.

• When taking folic acid, a higher dose than 400 mcg of folic acid each day is not necessarily better to prevent neural tube defects, unless a doctor recommends taking more due to other health conditions.
  • When planning to become pregnant, women who have already had a pregnancy affected by a neural tube defect should consult with their healthcare provider. CDC recommends that these women consume4,000 mcgof folic acid each day one month before becoming pregnant and through the first 3 months of pregnancy.

CDC recommends that women of reproductive age who could become pregnant consume at least 400 micrograms (mcg) of folate every day. However, it’s difficult to get 400 mcg of folate through diet alone. You can get 400 mcg of folic acid each day by taking a vitamin with folic acid in it, eating fortified foods, or a combination of the two, in addition to consuming a balanced diet rich in natural food folate.

During early development, folic acid helps form the neural tube. Neural tube defects, which are serious birth defects of the brain and spinal cord, develop very early during pregnancy when the neural tube—which forms the early brain and the spinal cord—does not close properly.

Folic acid is very important because it can help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).

The baby’s neural tube closes during the first weeks of pregnancy, often before a woman knows that she is pregnant. If a woman consumes folic acid before and during early pregnancy, it can help increase the chance of her baby’s neural tube closing properly. Waiting until the first prenatal visit (typically, the 6th to 12th week of pregnancy) to start folic acid consumption will not prevent neural tube defects. Therefore, to help prevent neural tube defects, it is important for women to start folic acid consumption before pregnancy begins.

The brain is a complex organ composed of gray parts and white matter, which can be hard to distinguish. Starting from an embryologic perspective allows you to understand more easily how the parts relate to each other. The embryonic nervous system begins as a very simple structure—essentially just a straight line, which then gets increasingly complex. Looking at the development of the nervous system with a couple of early snapshots makes it easier to understand the whole complex system.

Many structures that appear to be adjacent in the adult brain are not connected, and the connections that exist may seem arbitrary. But there is an underlying order to the system that comes from how different parts develop. By following the developmental pattern, it is possible to learn what the major regions of the nervous system are.

The Neural Tube

To begin, a sperm cell and an egg cell fuse to become a fertilized egg. The fertilized egg cell, or zygote, starts dividing to generate the cells that make up an entire organism. Sixteen days after fertilization, the developing embryo’s cells belong to one of three germ layers that give rise to the different tissues in the body. The endoderm, or inner tissue, is responsible for generating the lining tissues of various spaces within the body, such as the mucosae of the digestive and respiratory systems. The mesoderm, or middle tissue, gives rise to most of the muscle and connective tissues. Finally the ectoderm, or outer tissue, develops into the integumentary system (the skin) and the nervous system. It is probably not difficult to see that the outer tissue of the embryo becomes the outer covering of the body. But how is it responsible for the nervous system?

As the embryo develops, a portion of the ectoderm differentiates into a specialized region of neuroectoderm, which is the precursor for the tissue of the nervous system. Molecular signals induce cells in this region to differentiate into the neuroepithelium, forming a neural plate. The cells then begin to change shape, causing the tissue to buckle and fold inward (image). A neural groove forms, visible as a line along the dorsal surface of the embryo. The ridge-like edge on either side of the neural groove is referred as the neural fold. As the neural folds come together and converge, the underlying structure forms into a tube just beneath the ectoderm called the neural tube. Cells from the neural folds then separate from the ectoderm to form a cluster of cells referred to as the neural crest, which runs lateral to the neural tube. The neural crest migrates away from the nascent, or embryonic, central nervous system (CNS) that will form along the neural groove and develops into several parts of the peripheral nervous system (PNS), including the enteric nervous tissue. Many tissues that are not part of the nervous system also arise from the neural crest, such as craniofacial cartilage and bone, and melanocytes.

At this point, the early nervous system is a simple, hollow tube. It runs from the anterior end of the embryo to the posterior end. Beginning at 25 days, the anterior end develops into the brain, and the posterior portion becomes the spinal cord. This is the most basic arrangement of tissue in the nervous system, and it gives rise to the more complex structures by the fourth week of development.

Folate (also known as vitamin B9) is necessary for the body to produce red blood cells and to prevent anemia. This vitamin is also necessary for the synthesis and maintenance of DNA and is especially important in cell division and growth in fetal development. Folic acid deficiency in pregnancy is a common cause of birth defects; defects of the neural tube, in which tissue surrounding the fetal spine or brain does not develop properly are one of the most common birth defects, occurring in about 1 in 1,000 infants.

Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely. There is usually nerve damage that causes at least some paralysis of the legs. In anencephaly, most of the brain and skull do not develop. Babies with anencephaly are usually either stillborn or die shortly after birth. Another type of defect, Chiari malformation, causes the brain tissue to extend into the spinal canal.

The exact causes of neural tube defects aren't known. You're at greater risk of having an infant with a neural tube defect if you

• Have obesity
• Have poorly controlled diabetes
• Take certain antiseizure medicines

Getting enough folic acid, a type of B vitamin, before and during pregnancy prevents most neural tube defects.

Neural tube defects are usually diagnosed before the infant is born, through lab or imaging tests. There is no cure for neural tube defects. The nerve damage and loss of function that are present at birth are usually permanent. However, a variety of treatments can sometimes prevent further damage and help with complications.

Taking folic acid might reduce the risk of having a premature baby or a baby with birth defects, such as certain types of heart problems. But more research is needed to understand how folic acid affects the risk of these conditions.

Folate that is naturally present in food is not harmful. However, you should not consume folate in supplements or fortified foods in amounts above the upper limit, unless recommended by a healthcare provider.

Taking large amounts of folate supplements might hide a vitamin B12 deficiency because these supplements can correct the anemia that the vitamin B12 deficiency causes, but not the nerve damage that the vitamin B12 deficiency also causes.

High doses of folic acid might increase the risk of colorectal cancer and possibly other cancers in some people. High doses can also lead to more folic acid in the body than it can use, but whether these increased folic acid levels are harmful is not completely clear.

The daily upper limits for folate from supplements and fortified foods and beverages are listed below.

Folate supplements can interact with several medications. Here are some examples:

• Folate supplements could interfere with methotrexate (Rheumatrex®, Trexall®) when taken to treat cancer.
• Taking anti-epileptic or anti-seizure medications, such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®) and valproate (Depacon®), could reduce blood levels of folate. Also, taking folate supplements could reduce blood levels of these medications.
• Taking sulfasalazine (Azulfidine®) for ulcerative colitis could reduce the body’s ability to absorb folate and cause folate deficiency.

Tell your doctor, pharmacist, and other healthcare providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Be sure to take 400 micrograms (mcg) of folic acid every day.

Folic acidis important because it can help prevent somemajor birth defects of the baby’s brain and spine. If you plan to or could become pregnant, you should consume 400 micrograms (mcg) of folic acid every day to ensure your baby’s proper development and growth. In addition to eating foods with folate from a varied diet, you can get folic acid from

• Taking a vitamin that has folic acid in it;
  • Most vitamins sold in the United States have the recommended daily amount of folic acid (400 mcg) that you need.
  • Vitamins can be found at most local pharmacy, grocery, or discount stores. Check the label on the bottle to be sure it contains 100% of the daily value of folic acid, which is 400 mcg.
• Eating fortified foods;
  • You can find folic acid in some breads, breakfast cereals, and corn masa flour.
  • Be sure to check the nutrient facts label and look for a product that has “100%” next to folate.
• Getting a combination of the two: taking a vitamin that has folic acid in it and eating fortified foods.

If you take a vitamin, make it easy to remember.

• Take it at the same time every day. For example, take it when you brush your teeth in the morning or when you eat breakfast.
• Leave the vitamin bottle somewhere you will notice it every day, like on the kitchen counter.

What about cost?

The Affordable Care Act, the health care reform law passed in 2010, requires most health plans to cover folic acid supplements (pills). Depending on your insurance, you may be able to get folic acid supplements at no cost to you.

Talk to your insurance company to find out what’s included in your plan.

It’s easy to get the folic acid you need. Just eat a bowl of cereal with 100% DV of folic acid – or take a vitamin with 100% DV of folic acid – every day.

Check the label.

When you are at the grocery store, look for foods with folic acid in them. Choose cereal that has 100% DV of folic acid.

Folic acid is also in foods like enriched breads, pastas, and other foods made with grains. Check the Nutrition Facts label.

If you buy vitamins, be sure to check the label for folic acid. This label shows a vitamin with 100% DV of folic acid.

Many healthy foods also have folate (a type of folic acid that is found naturally in some foods).

In addition to eating cereal with 100% DV of folic acid or taking a vitamin with 100% DV of folic acid, it’s important for women to eat foods with folate, such as:

• Spinach and other leafy greens
• Asparagus
• Oranges and orange juice
• Beans and peas

When you are pregnant, you need more of certain nutrients like protein, iron, folic acid, and iodine. It’s also important to get enough calcium.

Making smart food choices can help you have a healthy pregnancy and a healthy baby. Here are some ideas to help you eat healthy during pregnancy.

Follow a healthy eating pattern.

Eating healthy means following a healthy eating pattern that includes a variety of nutritious foods and drinks.

• Eat a variety of vegetables, fruits, whole grains, fat-free or low-fat dairy products, and protein foods.
• Choose foods and drinks with less added sugars, saturated fats, and sodium (salt).
• Limit refined grains and starches, which are in foods like cookies, white bread, and some snack foods.
• If you are feeling sick, try eating a piece of whole-grain toast or whole-grain crackers.

Get the right amount of calories for you.

Being pregnant doesn't mean you need to eat twice as much food.

• First trimester (first 12 weeks) – Most women don’t need any extra calories.
• Second trimester (13 to 26 weeks) – Most women need about 340 extra calories a day.
• Last trimester (after 26 weeks) – Most women need about 450 extra calories a day.

Ask your doctor or midwife about the right amount of calories for you during pregnancy.

Make healthy snack choices.

Examples of healthy snacks include:

• Low-fat or fat-free yogurt with fruit (look for options with no added sugar)
• Whole-grain crackers with fat-free or low-fat cheese
• Carrots with hummus

Take a prenatal vitamin with folic acid, iron, and iodine every day.

• Folic acid helps prevent some birth defects of the brain and spine.
• Iron and iodine help keep you and your baby healthy.

Talk with your doctor or nurse about a prenatal vitamin that’s right for you.

Eat 8 to 12 ounces of seafood each week.

Fish and shellfish have healthy fats that are good for you and your baby. But some fish is high in mercury, a metal that can hurt your baby’s development. It’s a good idea to eat seafood that is high in healthy fats but lower in mercury.

Best choices

These choices are lower in mercury, so you can eat 8 to 12 ounces a week.

• Canned light tuna
• Catfish
• Cod
• Herring
• Oysters
• Salmon
• Shad
• Shrimp
• Tilapia
• Trout

Good choices

You can eat 4 ounces of these fish a week if you don’t eat any other seafood that week.

• Canned or fresh white (albacore) tuna
• Chilean sea bass or striped bass
• Grouper
• Halibut
• Mahi-mahi
• Snapper
• Yellowfin tuna

Fish to avoid

Don’t eat bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish, or tilefish. They are high in mercury.

Don’t eat certain foods.

These foods may have bacteria in them that can hurt your baby. Stay away from:

• Raw (uncooked) or rare (undercooked) fish or shellfish, like sushi or oysters
• Soft cheeses (like feta, Brie, and goat cheese), unless they are pasteurized
• Raw or rare (undercooked) meats, poultry, or eggs
• Unpasteurized juices or milk
• Lunch or deli meats, smoked seafood, and hot dogs – unless they are heated until steaming hot
• Prepared salads like ham salad, chicken salad, or seafood salad
• Raw sprouts, including alfalfa, clover, radish, and mung bean sprouts

Limit drinks with caffeine and added sugars.

• If you drink coffee or tea, choose decaf. Pick unsweetened options and don’t add sugar.
• Drink water or seltzer instead of drinks with added sugars like soda, fruit drinks, and energy or sports drinks.

Don’t drink alcohol.

No amount of alcohol is safe during pregnancy.

How much should I eat?

Eating healthy foods and the right amount of calories helps you and your baby gain the proper amount of weight.

How much food you need depends on things like your weight before pregnancy, your age, and how fast you gain weight. If you’re at a healthy weight, the Centers for Disease Control and Prevention (CDC) says you need no extra calories in your first trimester, about 340 extra calories a day in your second trimester, and about 450 extra calories a day in your third trimester. You also may not need extra calories during the final weeks of pregnancy.

Check with your doctor about this. If you are not gaining the right amount of weight, your doctor may advise you to eat more calories. If you are gaining too much weight, you may need to cut down on calories. Each woman's needs are different. Your needs depend on if you were underweight, overweight, or obese before you became pregnant, or if you are having more than one baby.

What kinds of foods and beverages should I consume?

A healthy eating plan for pregnancy includes nutrient-rich foods and beverages. The 2015–2020 Dietary Guidelines for Americans recommend these foods and beverages each day

• fruits and vegetables (provide vitamins and fiber)
• whole grains, such as oatmeal, whole-grain bread, and brown rice (provide fiber, B vitamins, and other needed nutrients)
• fat-free or low-fat milk and milk products or nondairy soy, almond, rice, or other drinks with added calcium and vitamin D
• protein from healthy sources, such as beans and peas, eggs, lean meats, seafood that is low in mercury (up to 12 ounces per week), and unsalted nuts and seeds, if you can tolerate them and aren’t allergic to them.

A healthy eating plan also limits salt, solid fats (like butter, lard, and shortening), and sugar-sweetened drinks and foods.

Does your eating plan measure up? How can you improve your eating habits? Try eating fruit like berries or a banana with low-fat yogurt for breakfast, a salad with beans for lunch, and a lean chicken breast and steamed veggies for dinner. Think about things you can try. Write down your ideas in the space below and share them with your doctor.

What if I’m a vegetarian?

A vegetarian eating plan during pregnancy can be healthy. Consider the quality of your eating plan and talk to your health care professional to make sure you’re getting enough calcium, iron, protein, vitamin B12, vitamin D, and other needed nutrients. Your health care professional may also tell you to take vitamins and minerals that will help you meet your needs.

Do I have any special nutrition needs now that I am pregnant?

Yes. During pregnancy, you need more vitamins and minerals such as folate, iron, and calcium.

Getting the appropriate amount of folate is very important. Folate, a B vitamin also known as folic acid, may help prevent birth defects. Before pregnancy, you need 400 mcg per day from supplements or fortified foods, in addition to the folate you get naturally from foods and beverages. During pregnancy, you need 600 mcg. While breastfeeding, you need 500 mcg of folate per day. Foods high in folate include orange juice, strawberries, spinach, broccoli, beans, fortified breads, and fortified low-sugar breakfast cereals. These foods may even provide 100% of the daily value of folic acid per serving.

Most health care professionals tell women who are pregnant to take a prenatal vitamin every day and consume healthy foods, snacks, and beverages. Ask your doctor about what you should take.

What other new habits may help my weight gain?

Pregnancy can create some new food, beverage, and eating concerns. Meet the needs of your body and be more comfortable with these tips. Check with your health care professional with any concerns.

• Eat breakfast every day. If you feel sick to your stomach in the morning, try dry whole-wheat toast or whole-grain crackers when you first wake up. Eat them even before you get out of bed. Eat the rest of your breakfast (fruit, oatmeal, hot or cold cereal, or other foods) later in the morning.
• Eat high-fiber foods. Eating high-fiber foods, drinking water, and getting daily physical activity may help prevent constipation. Try to eat whole-grain cereals, brown rice, vegetables, fruits, and beans.
• If you have heartburn, eat small meals spread throughout the day. Try to eat slowly and avoid spicy and fatty foods (such as hot peppers or fried chicken). Have drinks between meals instead of with meals. Don’t lie down soon after eating.

What foods and drinks should I avoid?

Certain foods and drinks can harm your baby if you have them while you’re pregnant. Here’s a list of items you should avoid.

• Alcohol. Do not drink alcohol, such as wine, beer, or hard liquor.
• Caffeine. Enjoy decaf coffee or tea, drinks not sweetened with sugar, or water with a dash of juice. Avoid diet drinks, and limit drinks with caffeine to less than 200 mg per day—the amount in about 12 ounces of coffee.
• Fish that may have high levels of mercury (a substance that can build up in fish and harm an unborn baby). Limit white (albacore) tuna to 6 ounces per week. Do not eat king mackerel, marlin, orange roughy, shark, swordfish, or tilefish. To get the helpful nutrients in fish and shellfish, you may eat up to 12 ounces of seafood per week, choosing from many safe seafood choices, such as cod, salmon, and shrimp.
• Foods that may cause illness in you or your baby (from viruses, parasites, or bacteria such as Listeria or E. coli). Avoid soft cheeses made from unpasteurized or raw milk; raw cookie dough; undercooked meats, eggs, and seafood; and deli salads. Take care in choosing and preparing lunch meats, egg dishes, and meat spreads.
• Anything that is not food. Some pregnant women may crave something that is not food, such as laundry starch, clay, ashes, or paint chips. This may mean that you’re not getting the right amount of a nutrient. Talk to your health care professional if you crave something that isn’t food. He or she can help you get the right amount of nutrients.