Folic Acid: Why It's Crucial Before and During Pregnancy
You're planning to have a baby. Or you've just found out you're pregnant. Everyone tells you one thing: "Take folic acid!". The doctor prescribes it, the pharmacist confirms, your friend's mum adds: "Get the one with methyl, because of the mutation!". And you're sitting with questions: why is it so important? How much to take? What even is this MTHFR? And is regular folic acid from the pharmacy enough, or do you need to buy expensive methylfolate?
Today we'll answer all those questions. Without unnecessary panic, but without trivialising either. Because folic acid isn't a doctor's whim - it's one of the most important substances for your child's health. And it's good for you to know why.
What is folic acid and why do we need folate?
Let's start with the basics. Folic acid (vitamin B9) is a synthetic form of folate - a vitamin that occurs naturally in food.
Why do we need folate?
Folate is essential for:
- Cell division - without it, DNA cannot replicate properly
- Red blood cell production - deficiency leads to anaemia
- Neurotransmitter synthesis - affects mood and brain function
- Homocysteine metabolism - high homocysteine is a risk factor for heart disease
During pregnancy, the need increases dramatically - the developing baby requires an enormous number of new cells. Especially in the first weeks, when the neural tube forms (which will become the brain and spinal cord).
Why is folic acid so important in pregnancy?
Let's be straight here: folic acid prevents the most serious birth defects - neural tube defects (NTDs).
What are neural tube defects?
These are a group of birth defects that occur when the neural tube doesn't close properly in the first 28 days of pregnancy. The most common are:
- Spina bifida - the spinal cord and nerves aren't fully enclosed, leading to serious neurological problems
- Anencephaly - absence of part of the brain and skull, a condition incompatible with life
- Encephalocele - part of the brain protrudes through an opening in the skull
How effective is folic acid?
Extremely effective. Studies show that folic acid supplementation before pregnancy and in early pregnancy:
- Reduces the risk of neural tube defects by 50-70%
- Reduces the risk of heart defects by about 25%
- May reduce the risk of cleft palate and lip
- Lowers the risk of premature birth
This is one of the greatest public health successes of recent decades. Thanks to supplementation and food fortification with folic acid, the number of children born with neural tube defects has been halved.
When to start taking folic acid?
And here's the crucial point that many women miss.
You don't start when you find out you're pregnant.
You start when you're planning a pregnancy - at least one month before conception.
Why so early?
Because the neural tube closes on day 28 of pregnancy. That's 4 weeks from the last period - often at a time when a woman doesn't yet know she's pregnant.
If you start taking folic acid only after a positive test (week 5-6 of pregnancy), it may be too late for full protection against neural tube defects.
Practical advice:
- Planning a pregnancy? Start supplementation at least one month beforehand (ideally 3 months)
- Not using contraception? Take folic acid "just in case"
- Just found out you're pregnant? Start immediately - better late than never
How long to take it? Throughout the entire first trimester (minimum until week 12 of pregnancy). Many doctors recommend taking it throughout the entire pregnancy and while breastfeeding.
How much folic acid to take?
It depends on your situation.
Standard dose (most women):
400 mcg (0.4 mg) daily
This is the dose for healthy women without risk factors. Most OTC (over-the-counter) products contain exactly 400 mcg.
High dose (5 mg = 5000 mcg) - who needs it?
A higher dose (available on prescription) is recommended if:
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Compare prices- You've had a previous pregnancy with a neural tube defect - recurrence risk: 2-5%
- You or your partner have a neural tube defect
- There have been cases of neural tube defects in the family
- You have diabetes (increases the risk of birth defects)
- You are obese (BMI above 30 - higher needs)
- You're taking anti-epileptic drugs (carbamazepine, valproate - disrupt folate metabolism)
- You have coeliac disease or inflammatory bowel disease (poorer absorption)
Important: High doses (5 mg) require medical consultation. Don't increase the dose on your own.
MTHFR - what is it and should you get tested?
MTHFR is a gene that codes for the enzyme responsible for converting folic acid into its active form (5-MTHF - 5-methyltetrahydrofolate).
MTHFR mutation - what does it mean?
About 40-50% of the population has a variant of the MTHFR gene (C677T or A1298C) that reduces the activity of this enzyme by 30-70%.
The effect? The body processes synthetic folic acid from supplements and fortified food less effectively. This can lead to:
- Higher homocysteine levels (a risk factor for heart disease and pregnancy complications)
- Active folate deficiency (despite supplementation!)
- Potentially higher risk of neural tube defects (although the data is inconclusive)
Should every woman get tested?
There's no definitive answer. Guidelines vary across countries.
When it's worth considering an MTHFR test:
- You've had miscarriages or difficulty conceiving
- There have been neural tube defects in the family
- You have elevated homocysteine levels
- You have autoimmune diseases, migraines, depression (controversial, but some doctors recommend it)
For most women, the test isn't necessary. Why? Because the solution is simple - regardless of whether you have the mutation or not, you can simply take the active form of folate (methylfolate). Problem solved.
Folic acid vs methylfolate - which to choose?
This is a common question at the pharmacy.
Folic acid (synthetic form)
Pros:
- Cheap
- Widely available
- Effective for most people
- Well researched
Cons:
- Requires conversion to the active form (a problem with MTHFR mutation)
- Excess unmetabolised folic acid (UMFA) in the blood - potentially undesirable (controversial)
Methylfolate (5-MTHF, Quatrefolic, Metafolin)
Pros:
- Active form - ready for the body to use
- Works in people with the MTHFR mutation
- Doesn't accumulate as unmetabolised folic acid
- Better absorbed (higher bioavailability)
Cons:
- More expensive (sometimes 2-3 times more)
- Less widely available (though increasingly found in pharmacies)
Which to choose?
Practical advice:
- If you have a confirmed MTHFR mutation - choose methylfolate
- If you have elevated homocysteine - methylfolate
- If you want to be on the safe side and not worry about a possible mutation - methylfolate
- If your budget is limited - regular folic acid is perfectly fine (proven effectiveness in studies!)
The most important thing is to take folate at all - the form is a secondary concern.
Dietary sources of folate
Supplementation is one thing, but diet also matters. Folate occurs naturally in food.
Best sources of folate:
Leafy greens (dark green):
- Spinach (263 mcg per cup cooked)
- Broccoli (104 mcg per cup)
- Brussels sprouts (94 mcg per cup)
- Asparagus (262 mcg per cup)
Legumes:
- Lentils (358 mcg per cup cooked)
- Chickpeas (282 mcg per cup)
- Black beans (256 mcg per cup)
Fruits:
- Avocado (90 mcg per half)
- Oranges (50 mcg each)
- Bananas (24 mcg each)
Fortified products:
- Breakfast cereals (often 100-400 mcg per serving)
- Bread (mandatory fortification in some countries)
Is diet enough?
Unfortunately no. Even with a balanced diet, it's difficult to reach 400 mcg of folate per day. Additionally:
- Folate from food is less stable (destroyed by cooking)
- Absorption is lower than from supplements
Supplementation is necessary. Diet is an addition, not a substitute.
Can you overdose on folic acid?
Folic acid is water-soluble, so the excess is excreted in urine. Overdose in the classic sense is very rare.
But there are concerns with high doses:
- Masking vitamin B12 deficiency - high doses of folate can hide B12 deficiency anaemia (which delays diagnosis and leads to irreversible neurological damage)
- Unmetabolised folic acid (UMFA) - appears at doses above 1000 mcg. Potential risk (controversial): immune system issues, masking B12 deficiency
Practical advice:
- Don't exceed 1000 mcg daily without medical consultation
- If taking high doses (5 mg on prescription), do so under medical supervision
- Consider vitamin B12 supplementation (especially if you're vegetarian/vegan)
What else besides folic acid?
Folate is the foundation, but not the only substance important in pregnancy.
Other key nutrients:
- Vitamin B12 - works together with folate, essential for the child's nervous system (vegetarians - supplement!)
- Vitamin D - 2000 IU daily (most Europeans are deficient)
- Iodine - 150-200 mcg daily (child's brain development)
- Iron - often needed in the 2nd and 3rd trimesters (pregnancy anaemia)
- Omega-3 (DHA) - child's brain and eye development
A comprehensive prenatal supplement (so-called "pregnancy vitamins") usually contains all these nutrients in appropriate doses.
Check prices on CheaperForDrug - differences between pharmacies can reach 8-10 EUR per pack.
Frequently asked questions
Can I take regular folic acid from the pharmacy for 3 EUR?
Yes! If it contains 400 mcg of folic acid - it's perfectly fine. You don't need to buy the most expensive product.
Does folic acid help with getting pregnant?
Directly - probably not. But it supports reproductive system health and may improve egg quality. It won't hurt and may help.
Should my partner also take folic acid?
Some studies suggest that folate may improve sperm quality. It's not essential, but if you're having trouble conceiving - worth trying (400 mcg daily for 3 months before planned conception).
Can I take too much folic acid?
At the standard dose (400 mcg) - no. At doses above 1000 mcg daily for a long time - problems may appear. Stick to the recommendations.
What if I forgot to take my folic acid?
Take it as soon as you remember. If it's the next day - take one dose (don't double up!). Occasional missing a dose is not a disaster.
Summary - what to remember
Folic acid is crucial - reduces the risk of neural tube defects by 50-70%.
Start at least one month before planned pregnancy (ideally 3 months). Don't wait for a positive test!
Standard dose: 400 mcg daily. Higher (5 mg) only on prescription for those with risk factors.
MTHFR mutation? Consider methylfolate. But regular folic acid also works for most people.
Diet + supplement - one doesn't replace the other. Eat leafy greens and legumes, but supplement.
Not just folate - vitamin B12, D, iodine, omega-3 are also important. Consider a comprehensive prenatal supplement.
Compare prices - the same supplement can cost 5-10 EUR less at a different pharmacy. Check CheaperForDrug.
Disclaimer
This information is for educational purposes and does not constitute medical advice. If you're planning a pregnancy, are pregnant, or have risk factors (diabetes, obesity, MTHFR mutation, taking medication) - consult your doctor about dosage. Every pregnancy is different and may require an individual approach.
Folic acid is a simple, affordable, and incredibly effective intervention that can protect your child from serious birth defects. Start today - don't put it off until tomorrow. And if you're looking for a good product at a reasonable price - check the comparison on CheaperForDrug. Because your child's health begins even before conception.