Why Is Folic Acid So Important During Pregnancy?

By Gabrielle McPherson, MS, RDN, LDN

A pregnant woman reviews the contents of her prenatal vitamin for folic acid content

If you’re an expecting parent, trying to conceive, or are simply struck with baby fever, you may have seen mention of folic acid in doctor’s waiting rooms, pregnancy magazines, or reproductive apps. So, what’s the fuss over folic acid? Here’s everything you need to know about this prenatal staple.

Folic Acid vs. Folate for Pregnancy

To function well, your body needs a total of eight water-soluble B vitamins—including the probably familiar-sounding B6 and B12. Vitamin B9, another member of the B vitamin clan, goes by another name: folic acid or folate. Often the two terms are used interchangeably, but they’re actually different!

Folic acid is the manmade form of vitamin B9. It’s added to breakfast cereals, rice, and flour to help Americans better meet nutrient needs and prevent deficiencies. In fact, in 1998, the Food and Drug Administration (FDA) created a mandate for cereals to contain certain levels of folic acid to prevent birth defects in pregnancy. The body absorbs about 85% of available folic acid.

Folate is the natural form of vitamin B9. You can find folate in many foods, from grapefruits to eggs to sunflower seeds. The body can only absorb about 50% of available folate, so folic acid is a little more efficient. Still, that’s no excuse to rely on folic acid supplements alone! Everyone, pregnant or not, should aim to eat plenty of folate-rich foods.

High Folate Foods for Pregnancy

Dark leafy greens (mustard greens, turnip greens, kale, and spinach)
Beets
Citrus fruits
Low-mercury fish
Legumes (beans, lentils, and peas)

Why Folic Acid Is So Important During Pregnancy

All pregnancies need folic acid to support healthy red blood cells and brain and spine formation in growing babies. About 3,000 babies are born with neural tube defects (NTDs) in the U.S. each year, which is one consequence of being short on folic acid.

NTDs happen when the brain and spine don’t close as they should. The two most common forms of NTDs are spina bifida (spine defect) and anencephaly (brain defect). In the 1980s, 13,600 babies were born with spina bifida without anencephaly, and 3,800 died because of these abnormalities. One study found that after foods became fortified with folic acid, spina bifida prevalence dropped overall by 23%. What’s more, there was a significant decrease in the severity of certain types of spina bifida.

Aside from its connection to neural tube development, the exact science behind folic acid and its impact on pregnancy isn’t well understood, but we do know that it’s critical to making DNA, your baby’s genetic blueprint. Developing babies depend on folic acid to form healthy cells during times of rapid growth, which lasts the entire pregnancy. Taking folic acid throughout the pregnancy is essential to avoid low levels. Insufficient folic acid can limit a baby from reaching its full growth potential in the womb and lead to early delivery. That’s why folic acid is a key ingredient in all prenatal vitamins!

When to Start Taking Folic Acid for Pregnancy

Folic acid a must-have nutrient for brain growth beginning as early as three weeks gestation! (That’s well before those double lines show up on a pregnancy test around five or six weeks)!) Some research encourages supplementing with folic acid five to six months before conceiving, but the CDC’s official recommendation is to supplement one month prior. Many birth defects occur in early pregnancy, so loading up on the nutrient as early as possible can benefit your babe in the long run.

How Much Folic Acid to Take for Pregnancy

If you’re pregnant or trying to get pregnant, you should take a prenatal vitamin with at least 400 micrograms of folic acid daily, according to the CDC and the American College of Obstetrics and Gynecology (ACOG). This will go a long way to deliver the essential folic acid you need. However, ACOG says during pregnancy, the total recommended daily intake is actually 600 micrograms. Because most prenatals are shy of that, you should plan on getting folate-rich food into rotation as well.

However, it’s important to know that relying on folate-rich foods alone is usually insufficient to support a healthy pregnancy, so supplementation is still necessary. The truth is your body absorbs folic acid much more efficiently than folate. And according to the 2020-2025 Dietary Guidelines for Americans (DGAs), only folic acid (not folate) has been proven to help prevent neural tube defects. Your best bet is to eat good sources of folate and take a folic acid in supplement form.

Final Thoughts on Folic Acid and Pregnancy

If you’re pregnant or considering pregnancy, speak with your medical provider about folic acid supplementation. Before buying a prenatal vitamin, check the nutrition facts label to ensure it has at least 400 micrograms of folic acid per serving. People who have had a baby with neural tube defects are at a higher risk of another occurrence, so further supplementation may be necessary in those cases—your doctor will be able to advise on the right amount for you and your growing baby!

About Gabrielle McPherson

Gabrielle McPherson, MS, RDN, LDN is registered dietitian in Missouri who specializes in community and pediatric nutrition. Gaby is passionate about encouraging families to eat well in simple, practical ways that are realistic...and delicious! When not working, Gaby loves cooking, baking, and making messes and memories with her sous-chef/preschooler Charlotte.

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.

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