The Arkansas Folic Acid Coalition and the March of Dimes recommends that all women who can become pregnant consume a multivitamin containing 400 micrograms of folic acid daily, in addition to eating a healthy diet including foods rich in folic acid. This is the only sure way a woman can get all the folic acid and other vitamins she needs. Most women get only about 200 micrograms of folic acid a day from their diets.

Foods that are naturally rich in folates (the natural forms of folic acid found in foods) include: orange juice, pineapple juice, kiwi, cantaloupe, oranges, strawberries, spinach, collards, turnip and mustard greens, kidney and black beans, black-eyed peas, lentils, broccoli, asparagus, whole-grain products, and peanuts. Multivitamins, fortified breakfast cereals, and enriched grain products contain a synthetic form of folic acid that is more easily absorbed by the body than the natural form (which must be broken down by the body into a usable form). It is not yet known whether consuming 400 micrograms of folate from foods every day provides the same level of protection against birth defects as 400 micrograms of the synthetic form. This is because cooking and storage can destroy some of the folate in foods, and the amount of usable folic acid the body can obtain from different foods varies widely.

The body can absorb almost 100 percent of the synthetic form of folic acid. This is why the Arkansas Folic Acid Coalition, the March of Dimes, the Centers for Disease Control and Prevention (CDC), and the Institute of Medicine recommend that women who could become pregnant consume 400 micrograms a day of the synthetic form. Because some fortified breakfast cereals contain 400 micrograms of folic acid in one bowl, a woman could get the recommended amount of synthetic folic acid this way, or she can take a multivitamin.

The Institute of Medicine also recommends that women should increase their intake of synthetic folic acid to 600 micrograms a day once their pregnancy is confirmed. Most doctors recommend a prenatal vitamin that contains at least this amount of folic acid. However, women should not take more than 1,000 micrograms (or 1 milligram) without their doctor's advice.

If a woman has already had a baby with an NTD, she should consult her doctor before her next pregnancy about the amount of folic acid she should take. Studies have shown that taking a larger dose of folic acid daily (4 milligrams), beginning at least one month before pregnancy and in the first trimester of pregnancy, reduces the risk of having another affected pregnancy by about 70 percent.

How much folic acid is in fortified foods?

As of January 1, 1998, the U.S. Food and Drug Administration has required the addition of 140 micrograms of folic acid per 100 grams of grain product to cereals, breads, pastas, and other foods labeled "enriched." (Several cereals contain the recommended daily amount of 400 micrograms per serving, but most contain from 25 to 50 percent.) This makes it a little easier for women to obtain folic acid from their diets. Currently most women do not obtain enough folic acid from their diet alone. Eating habits will need to change to select enriched foods with higher fortification levels and to include fruits and vegetables - which is also heart healthy. The FDA did not require that more folic acid be added to enriched foods because of the concern that folic acid might mask one sign of a potentially dangerous condition called pernicious anemia, that is seen mainly in elderly people. The level of fortification the FDA currently requires is believed to be safe for everyone.

For example, a recent study found that as many as one in seven people may carry a genetic mutation (change) that causes them to have a deficiency in folic acid, even if they are consuming a diet that contains the recommended amount of folates. These people have problems breaking down folates found in food to forms of folic acid the body can use, resulting in lower folic acid levels in the blood. Studies suggest that women with this gene mutation may be at increased risk of having a baby with an NTD. However, taking synthetic folic acid either by pill or fortified food appears to raise levels of the vitamin in the blood, and thereby reduce the risk of having an affected baby.

One of these researchers is focusing on 5 genes that play a key role in how the body breaks down food folates, to see if mutations in any of these genes increase the risk of spina bifida. Another researcher is looking at how folic acid is transferred from the placenta to the fetus, and trying to identify any factors that could interfere with this process. These studies could lead to ways to identify women who are at increased risk of having a baby with an NTD, and to improved ways to treat them, with the goal of preventing even more NTDs than is currently possible.

The information and resources listed here are intended for educational use only. The information provided on this web site should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. Always contact your physician and/or other qualified healthcare professional before starting any new treatment or with questions about your health.

HOME  /  BACK TO TOP  /  CONTACT US