I Found Out I’m Pregnant But I Haven’t Been Taking Folic Acid. What Should I Do?

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No Folic Acid

Folic acid is the man-made form of folate or vitamin B9. B vitamins are water-soluble vitamins, which means that excess of the vitamin is eliminated by the body through the urine every day and requires daily dosing. Folic acid and folate help make healthy red blood cells that transport oxygen.1 Everyone needs folic acid; women who are thinking about becoming pregnant or who are pregnant also need adequate vitamins and minerals such as folic acid.1 It is reported that 400 micrograms of folic acid daily started before pregnancy through 6-12 weeks gestation decreases the neural tube defect rate by 75%.2 National and international guidance consistently recommends that all women get at least 400 micrograms of folic acid every day.3,4,7 Women of reproductive age (15 to 45 years old) who can get pregnant or who are pregnant should get 400 to 800 micrograms of folic acid daily.1 Many doctors will prescribe prenatal vitamins with folic acid to make sure women are getting the recommended daily dose of folic acid.5

In women planning to become pregnant, folic acid supplements are typically started at least 4 weeks before conception and continued throughout pregnancy.2 In addition to helping form healthy red blood cells, folic acid helps prevent folate-deficiency anemia and birth defects that affect the spine, spinal cord, and brain- also known as neural tube defects.1 Neural tube defects are estimated to affect 1.5 per 1,000 pregnancies.2 These defects include spina bifida (impaired spinal cord development that affects nerves and mobility) and anencephaly (impaired brain or skull development).1 The risk of a fetus developing neural tube defects is highest during the first 3-4 weeks of pregnancy when the brain and spinal cord are developing.5 Many women may not even know they are pregnant until several weeks after conception.

Half of all pregnancies in the United States are not planned so adequate folic acid intake is essential for women.1 So, what if you find out you’re pregnant and you haven’t been taking folic acid?

  • Start taking 400 to 800 micrograms of folic acid daily as soon as you can.6
  • Confirm and discuss your pregnancy with your doctor.6

It is important to remember that some women get enough folic acid through the foods they eat.1 Foods such as rice, cornmeal, flour, bread, and pasta are often fortified or enriched with folic acid. Breakfast cereals also contain folic acid, many with 100% ( 400 micrograms) of the recommended daily intake for women.1 Folic acid is related to folate, which is found in dark, leafy green vegetables, oranges, beans, and chicken.1

Certain women may be at a greater risk of not getting enough folic acid every day.1 Of course, pregnant women need 400-800 micrograms of folic acid daily. But, African American and Spanish-speaking Mexican American women are less likely to get the recommended daily dose of folic acid. And, women who have had a child with spina bifida, a family member with spina bifida, or have spina bifida themselves should have 4,000 micrograms of folic acid daily.1

New research suggests that some women’s bodies may process folic acid differently, making it harder for the body to use the folic acid. In order to help these women, L-methylfolate supplements may be used.4 It is always important to discuss any supplement use with your doctor.

Women with coexisting disease (ex. kidney disease, lupus, diabetes, rheumatoid arthritis, celiac disease, etc.) before or during pregnancy should speak with their doctor to ensure that they are receiving the proper prenatal care and folic acid supplementation.1

Additional resources:

References:

  1. https://www.womenshealth.gov/a-z-topics/folic-acid
  2. http://www.aafp.org/afp/2014/0201/p199.html
  3. https://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/
  5. https://www.cdc.gov/ncbddd/folicacid/recommendations.html
  6. https://www.womenshealth.gov/pregnancy/you-get-pregnant/unplanned-pregnancy
  7. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/
Lauren McMahan
Dr. Lauren McMahan has a Doctor of Pharmacy from Lipscomb University College of Pharmacy in Nashville, TN. She currently works for a large national healthcare company, where she provides her research and writing expertise to support evidence-based initiatives to improve patient care. She enjoys exercising, reading, and thrifting in her spare time.

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