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Folic Acid

Folic acid, sometimes called folate, (B9) found mostly in leafy green vegetables like kale and spinach, orange juice, and enriched grains.

Folate is needed while you are trying to conceive as well as in the first weeks of pregnancy. It can help reduce the risk of certain serious and common birth defects called neural tube defects, which affect the brain and spinal cord.

The CDC and the U.S. Public Health Service urge every woman who could become pregnant to get 400 micrograms (400 mcg) of synthetic folic acid every day.

How much is enough? Look for 100%
One easy way a woman can be sure she is getting enough folic acid is to take a vitamin that has folic acid in it every day. Folic acid pills and most multivitamins sold in the U.S. have 100% of the daily value (DV) of folic acid; check the label to be sure. Another way to get enough is to eat a serving of breakfast cereal every day that has been enriched with 100% of the daily value of folic acid. Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

When to start - Today! Every day!

These birth defects happen in the first few weeks, often before a woman finds out that she is pregnant. All women should practice this habit of taking folic acid daily even when they are not planning to get pregnant. For folic acid to help, it needs to be taken every day starting before a woman becomes pregnant.

Repeated studies have shown that women who get 400 micrograms (0.4 milligrams) daily prior to conception and during early pregnancy reduce the risk that their baby will be born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70%. The tricky part is that neural tube defects can occur in an embryo before a woman realizes she's pregnant. That's why it's important for all women of childbearing age (15 to 45) to include folate in their diets: If they get pregnant, it reduces the chance of the baby having a birth defect of the brain or spinal cord.

Anencephaly and Spina Bifida
These are the technical names of the two major neural tube birth defects. Babies with anencephaly do not develop a brain and are stillborn or die shortly after birth. Those with spina bifida have a defect of the spinal column that can result in varying degrees of handicap, from mild and hardly noticeable cases of scoliosis (a sideways bending of the spine) to paralysis and bladder or bowel incontinence.

With proper medical treatment, most babies born with spina bifida can survive to adulthood. But they may require leg braces, crutches, and other devices to help them walk, and they may have learning disabilities. About 30 percent have slight to severe mental retardation. All of these defects occur during the first 28 days of pregnancy - usually before a woman even knows she's pregnant.

Some of the maternal factors that may also contribute to the development of neural tube defects include:
family history of neural tube defects
prior neural tube defect-affected pregnancy
use of certain anti-seizure medications
severe overweight
hot tub use in early pregnancy
fever during early pregnancy
diabetes

All Women of Childbearing Age Should Take Folic Acid

All women should be taking folic acid—not just those who are planning to become pregnant. Only 50% of pregnancies are planned, so any woman who could become pregnant should make sure she's getting enough folic acid. Also, talk to your doctor if you've already had a pregnancy that was affected by a neural tube defect. She may recommend that you increase your daily intake of folic acid (even before getting pregnant) to lower your risk of having another occurrence.

Folic acid and folate are different words for the same B vitamin. Folic acid is the man-made type of the B vitamin that is used in vitamin supplements and added to certain foods (called enriched or fortified foods). Folate is the natural type of the B vitamin and it is already a part of some foods. The biggest difference between folic acid and folate is that folic acid is used more easily by the body than folate.

Getting Enough Folate
Folate occurs naturally in a variety of foods including liver; dark-green leafy vegetables such as collards, turnip greens, and Romaine lettuce; broccoli and asparagus; citrus fruits and juices; whole-grain products; wheat germ; and dried beans and peas, such as pinto, navy and lima beans, and chickpeas and black-eyed peas.

Under the FDA's folic acid fortification program, which became effective January 1998, manufacturers are required to add from 0.43 mg to 1.4 mg of folic acid per pound of product to enriched flour, bread, rolls and buns, farina, corn grits, cornmeal, rice, and noodle products. A serving of each product will provide about 10 percent of the Daily Value for folic acid.

Whole-grain products do not have to be enriched because they contain natural folate. Some of the natural folate in non-whole-grain products is lost in the process of refining whole grains. Folate also can be obtained from dietary supplements, such as folic acid tablets and multivitamins with folic acid, and from fortified breakfast cereals.

Nutrition information on food and dietary supplement labels can help women determine whether they are getting enough folate. You should be getting 400 micrograms (0.4 milligrams) a day before pregnancy and 800 micrograms a day during pregnancy.

Certain information on food and dietary supplement labels can help women spot foods containing substantial amounts of folate. Some labels may claim that the product is "high in folate or folic acid," which means a serving of the food provides 20 percent or more of the Daily Value for folic acid. Or the label may say the food is a "good source" of folate. This means a serving of the food provides 10 to 19 percent of the Daily Value for folic acid. The exact amount will be given in the label's Nutrition Facts panel.

Some food and dietary supplement labels may carry a longer claim that says adequate folate intake may reduce the risk of neural tube birth defects.

Products carrying this claim must:
Provide 10 percent or more of the Daily Value for folic acid per serving
Not contain more than 100 percent of the Daily Value for vitamins A and D per serving because high intakes of these vitamins are associated with other birth defects
Carry a caution on the label about excess folic acid intake, if a serving of food provides more than 100 percent of the Daily Value for folic acid.
FDA has set 1 mg (or 1,000 micrograms) of folate daily as the maximum safe level. There are limited data on the safety of consuming more than 1 mg daily, and there may be a risk for people with low amounts of vitamin B12 in their bodies--for example, older people with malabsorption problems, and people on certain anticancer drugs or drugs for epilepsy whose effectiveness can diminish when taken with high intakes of folate.

List on the label's Nutrition or Supplement Facts panel the amount by weight in micrograms and the %Daily Value of folate per serving of the product. This information, which appears toward the bottom of the panel, along with the listing of other vitamins and minerals, can be used to compare folate levels in various foods and supplements.

Pregnancy Plus Prenatal Vitamins
These vitamins are free of artificial dyes, flavors or preservatives and provide 100% RDA of key nutrients like Iron, Vitamin C, Vitamin A (as beta-carotene), and folic acid - important in preventing birth defects.