Folic Acid: The Public Health Perspective
Taking folic acid before pregnancy is the single most effective way to reduce the risk of neural tube defects, such as spina bifida and anencephaly. Birth defects like spina bifida affect the spinal cord and can cause leg paralysis and bladder or bowel problems. Anencephaly occurs when a baby is born with an underdeveloped brain and skull and is fatal. By taking folic acid daily, a woman can reduce her risk of having a baby with a neural tube defect. In fact, taking folic acid can reduce a woman's risk of having a baby with neural tube defects by up to 70%.
In addition to reducing the risk for neural tube defects, prevention of neural tube defects can reduce healthcare costs. The annual medical care costs for people with spina bifida exceed $200 million in the United States and the total lifetime cost of care for a child born with spina bifida is estimated to be about $560,000.
Folic acid is important in the early weeks of pregnancy, before most women know they are pregnant. Because many pregnancies also go unplanned, taking folic acid is recommended for all women of childbearing age. But folic acid is not just recommended because of its effectiveness in reducing neural tube defects during pregnancy. It is recommended for many different reasons and for all women. By taking folic acid, you are taking care of yourself.
How does folic acid help?
For all women and men:
In the body, folic acid:
- May prevent heart disease and certain types of cancers
- May protect against depression and decline in cognitive functioning
- Is necessary for cell division and replication
- Helps in the formation of mature red blood cells and prevents a type of anemia called megaloblastic anemia
- Helps maintain heart health by lowering levels of homocysteine, a compound known to increase risk of cardiovascular complications
In the body, folic acid:
- Helps prevent birth defects
- Helps reduce risk of high blood pressure in pregnancy
- Helps prevent low birthweight
- Helps reduce risk of miscarriage
When is taking folic acid recommended?
Taking folic acid daily is recommended for all people, but especially for women in their childbearing years. When taken before pregnancy and in the early weeks of pregnancy, folic acid can reduce the risk of neural tube defects by 70%.
How much should a woman take?
For women in their childbearing years, 400 micrograms (mcgs) is recommended daily and 600 mcgs is recommended during pregnancy. This amount is usually found in a multivitamin or prenatal vitamin. To see how different multivitamins measure up, visit the National Institutes of Health’s Office of Dietary Supplements at: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#h2.
Folic Acid And The Food Supply
Folate is the natural form of folic acid, and is found in many foods. Folic acid is the synthetic form of folate. Because of the overwhelming benefits of folic acid, the FDA mandate of grain products fortification went into effect in 1998. This requires bread products, flour, corn grits, cornmeal, farina, rice, macaroni, and noodles to be fortified with folic acid. Breakfast cereals can be fortified with up to 100% of the recommended amount (400 mcgs) of folic acid per serving. Check the label on cereal boxes to make sure you’re getting the maximum amount in each serving.
After mandatory fortification of cereal grain products went into effect in January 1998, the reported prevalence of spina bifida declined 31%, and the prevalence of anencephaly declined 16% between October 1998 and December 1999.
Which foods contain folate?
Folate is naturally found in the following foods:
- beans, lentils and other legumes
- dark, leafy greens like spinach and broccoli
- citrus fruits like oranges
- other colorful fruits and vegetables
- nuts, peanuts and peanut butter
- sunflower seeds
- soy milk
For more information, visit:
Terri Mendoza, MS, RD, LDN
Nutrition Education Specialist
Massachusetts Department of Public Health
250 Washington St., 6th floor
Boston, MA 02108
Phone: (617) 624-6146
Fax: (617) 634-6179