Folate is one of the B-vitamins that is required by the body for the formation of red blood cells and white blood cells in the bone marrow. Folate also helps in converting carbohydrates into energy and is required for the production of DNA and other genetic material in the body. Folate is also important for proper growth and development during pregnancy and infancy.

Though ‘folate’ and ‘folic acid’ are often used interchangeably, they are different from each other. Folate is the naturally occurring vitamin B9 found in foods such as green vegetables, beans, nuts and seeds, while folic acid is the synthetic (man-made) form of vitamin B9, which is available in the form of supplements.

Why do women require folic acid during pregnancy?

Folic acid is extremely important during pregnancy as it can prevent the development of neural tube defects in the baby. Neural tube defects are birth defects characterized by incomplete growth of the brain and spinal cord. These defects develop within 28 days after conception. The babies born with neural tube defects may suffer from paralysis and long-term mental and physical disability. The most commonly seen neural tube defects include:

• Spina bifida: Incomplete closure of the spinal cord and spinal column
• Encephalocele: Protrusion of brain tissue into the skin due to an opening in the skull
• Anencephaly: Incomplete formation of the brain.

Other than preventing the formation of neural tube defects, the benefits of folic acid during pregnancy include:

• Reduction of risk of congenital heart defects in the baby significantly.
• Lower risk of cleft lip and cleft palate in the baby. Cleft lip and palate (incomplete closure of mouth or lips) usually occur during the first 10 weeks of pregnancy, thus early supplementation of folic acid can help prevent it.
• Reduced risk of low birth weight in the baby and maternal anaemia.

How much folic acid is required during pregnancy?

Women above the age of 19 years must take 400 micrograms (mcg) of folic acid every day. During pregnancy, the demand for folic acid increases to 600 micrograms (mcg) daily. Some women may require more than the advised amount of folic acids. Such women include those:

• With chronic diseases such as kidney disease, liver disease, diabetes, asthma, lupus and inflammatory bowel disease 
• Who consume more than one alcoholic beverage daily
• With sickle cell disease
• Who taking medications for epilepsy
• With a family history of neural tube defects
• Who has given birth to a child with neural tube defects.

When should women start taking folic acid? 

It is advised that women who wish to get pregnant or are trying for the same should start taking folic acid even before they conceive. This is because neural tube defects usually occur within 28 days of conceiving and by this time even the woman does not know about their pregnancy. Taking supplements before pregnancy can help in reducing the risk of neural tube defects in the baby.

What are the natural food sources of folic acid?

The natural sources of folic acid include:

• Whole grains (can be consumed in the form of whole wheat pasta and bread)
• Dark green leafy vegetables such as spinach, broccoli, asparagus and lettuce
• Peas
• Chickpeas, kidney beans, soybeans and other types of beans
• Nuts and seeds such as peanuts, almonds, sunflower seeds and flax seeds
• Citrus fruits such as oranges, lemons and amla (Indian gooseberry)
• Seafood (crabs and fishes)
• Eggs
• Breakfast cereals with fortified folic acid.

Can pregnant women take folic acid supplements?

Since it is not possible to get the required amount of folic acid just from food, pregnant women are prescribed folic acid supplements. Folic acid supplements are one of the many prenatal vitamins prescribed to pregnant women.

These supplements can be consumed along with a folate-rich diet, however, the dose of the supplements must be monitored as one must not take more than 1000 micrograms of folic acid every day.

Takeaway

Folic acid is one of the important nutrients that is required by women during their reproductive age, i.e., 15 to 49 years as per the World Health Organization (WHO). Women must talk to their doctor about the right dosage of folic acid if they are planning on getting pregnant. To reduce the risk of neural tube defects in the baby, pregnant women should get their folic acid levels tested frequently. In case of any doubts, pregnant women must consult their gynaecologist.