Why is Folic Acid Given and How Long Should it Be Taken?

Answer to the main question: Why and for how long is folic acid needed?

In preparation for pregnancy and during the early weeks, this topic is of particular importance. Folic acid, a synthetic form of vitamin B9, plays a critical role in the proper development of your baby's brain and spinal cord during the first weeks of pregnancy. Its primary purpose is to significantly reduce the risk of neural tube defects (NTDs), including spinal hernia known as spina bifida.

Key rule: If you are planning to conceive or have just learned you are pregnant, start taking 400 micrograms (mcg) of folic acid daily immediately. It is recommended to continue this intake for at least the first 12 weeks of pregnancy.

If you haven't taken folic acid until you found out you were pregnant, don't blame yourself; mention this to your medical team at your first appointment. This is a very common situation. The main thing is to start taking it as soon as you find out. Every pregnancy is different, and some women may need a different dose. For this reason, it is important to consult with your doctor or gynecologist at the earliest opportunity to determine the most suitable plan for you.

Folic acid and folate: What's the difference?

Although often used interchangeably, folic acid and folate are not the same. Understanding the difference between them helps to understand why supplement preparations are specifically recommended.

• Folate: This is the natural form of vitamin B9. It is naturally present in many foods such as green leafy vegetables (spinach, lettuce), legumes, and citrus fruits. Our body must convert folate from food into its active form to use it.
• Folic acid: This is the man-made, or synthetic, form of vitamin B9. It is used in vitamin supplements and fortified foods (such as some flours and breakfast cereals). Folic acid is more easily absorbed by the body, and its effectiveness in preventing neural tube defects has been proven by scientific research.

For this very reason, relying solely on folate-rich foods is not recommended. Taking a folic acid supplement is the most reliable way to ensure the required amount during pregnancy.

When to start and how long to continue?

The timing of folic acid intake is crucial for its effectiveness. The baby's neural tube forms very early in pregnancy, often before a woman even knows she is pregnant.

Ideal start time: Starting daily folic acid intake ideally 3 months before attempting to conceive is the most ideal option. This is the recommended approach for preparing for early pregnancy.

Duration of intake during pregnancy: From the moment pregnancy is confirmed, it is essential to continue intake at least until the end of the first 12 weeks. The neural tube forms in earlier weeks; the recommended additional period does not mean it only closes in the 12th week.

If you haven't started taking it during the pregnancy preparation period, don't worry. Start immediately as soon as you find out you are pregnant. It is beneficial to clarify the intake plan now, but starting later does not guarantee that all previous risks are eliminated.

Clarification of standard dose and units

Seeing different numbers and units on pharmacy shelves and vitamin boxes can be confusing. Let's clarify this issue. For most women planning or currently pregnant, the recommended standard daily dose is 400 micrograms (mcg).

Sometimes, different units may be indicated on the packaging. The table below will help you understand these units:

When choosing vitamins, carefully check the label and make sure it contains 400 mcg (or 0.4 mg) of folic acid. If you have any doubts, do not hesitate to ask a pharmacist or your doctor.

Who might need a high dose (5 mg) of folic acid?

In some cases, your doctor may determine that the risk of neural tube defects is higher and may prescribe a higher dose of folic acid – 5 milligram (mg) – instead of the standard 400 mcg. This should only be done by a doctor's decision, and a high dose should not be taken on your own.

Situations requiring a high dose are usually the following:

• If you or the baby's father have a neural tube defect (e.g., spina bifida).
• If you or the baby's father have a close relative with a neural tube defect.
• If your previous pregnancy resulted in a neural tube defect.
• If you have type 1 or type 2 diabetes.
• If you have a blood disorder such as sickle cell anemia or thalassemia.
• If you are taking certain medications for epilepsy (seizures) or HIV.

According to the UK's NICE (National Institute for Health and Care Excellence) guidelines, a high body mass index (BMI) alone is not a reason for a high dose, but local protocols may differ. It is always important to follow your treating doctor's prescription.

If you have undergone bariatric surgery, request an individualized specialist plan for folic acid and other micronutrients. High BMI or pre-eclampsia risk alone is not an indication for a high dose of folic acid according to NICE; other risks and local protocol are considered.

Food sources and choosing the right prenatal vitamin

Folate-rich foods are an important part of a healthy pregnancy diet. Foods such as spinach, broccoli, lentils, peas, and oranges are sources of folate. However, it can be difficult to meet the required amount during pregnancy solely through food. Folate in foods can also be easily broken down during cooking.

Therefore, taking additional preparations is important. When choosing a prenatal vitamin or separate folic acid, pay attention to the following points:

1. Check the dose: Make sure the box contains 400 mcg (or 0.4 mg) of folic acid.
2. Check the ingredients: Multivitamins intended for pregnancy are usually safe. However, if you are using regular multivitamins, be careful not to have vitamin A (retinol) in them. Excessive vitamin A intake during pregnancy can be harmful to the baby.
3. Avoid fish oil: Supplements such as cod liver oil containing retinol should not be taken during pregnancy.

Your doctor or pharmacist can help you choose the most suitable and reliable preparation.

What to do if you forget a tablet or experience nausea?

Forgetting a daily tablet can happen to anyone. The main thing is not to panic.

If a dose is missed: Take that dose as soon as you remember. However, if the time for the next dose is very close, skip the missed dose and continue with your schedule. Never take a double dose to compensate for a missed dose.

Nausea and vomiting: Some women, especially in the first months of pregnancy, suffer from nausea. If you vomit shortly after taking the tablet, do not rush to take a second tablet immediately. It is impossible to know how much of the medication has been absorbed. If this happens frequently, consult your doctor. They may recommend taking the tablet at a different time of day or with food.

Is folic acid needed after the first 12 weeks?

The most critical period for folic acid to prevent neural tube defects is the first 12 weeks. After this period, your doctor may discontinue a separate high-dose folic acid prescription if there are no other medical indications.

However, this does not mean that folic acid is completely unnecessary. It also plays a role in the formation of blood cells. Many multivitamin complexes intended for pregnancy are designed for intake throughout pregnancy and contain 400 mcg of folic acid. If your doctor sees a risk of anemia or another reason, they may advise you to continue taking folic acid for a longer period.

As always, discuss your vitamin intake plan after 12 weeks with your doctor. Do not stop any prescribed medication or vitamin without their recommendation.

Practical tips for not forgetting daily intake

There's already a lot to think about during pregnancy. Remembering a daily tablet can sometimes be difficult. These simple habits can help you:

• Associate with your daily routine: Take the tablet at the same time every day, for example, after breakfast or before brushing your teeth.
• Keep it in a visible place: Keep the vitamin box in the kitchen or a place you frequent, but out of reach of children.
• Set a reminder: Setting a daily reminder on your phone is one of the most effective methods.
• Mark on the calendar: Put a mark on the calendar after taking it every day.

Remember, this small habit is a big step you take for your baby's health. If you have any questions or concerns, do not hesitate to talk to your doctor or pharmacist.

You can use the Anacan Calendar to easily track your doctor's appointment dates and other important notes.