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Thinking about getting pregnant? Take folic acid

If you are planning to get pregnant, you should be taking folic acid. 

What is folic acid? 

Folic acid (also known as folate or folacin) is a B vitamin. Foods rich in folic acid include some grains, green vegetables (spinach, broccoli), meats (liver) and legumes (lentils and kidney beans). Although present in these foods, it can be hard to get enough folic acid from diet alone. 

Folate is essential to the normal development of your baby's spine, brain and skull, especially during the first four weeks of your pregnancy. It helps your baby’s neural tube develop properly during pregnancy and protects against neural tube defects (NTDs).  It may also lessen the risk of other problems in the newborn baby, such as cleft lip and palate or heart and urinary tract  defects.

What is a neural tube?

A baby’s central nervous system starts to develop early in pregnancy. When that happens a neural plate forms, which eventually folds in on itself and becomes the neural tube. One end of the neural tube forms the brain, and the rest of forms the spinal cord. By week six of a pregnancy, the openings in the neural tube usually close.

What is a neural tube defect?

Neural tube defects happen when one of the openings in the spinal cord does not close properly during early pregnancy. This leads to spina bifida or anencephaly. Spina bifida results when the spine does not develop normally. Anencephaly happens when the skull and brain don't form normally.

NTDs happen in 3-5 of every 10,000 babies born in Canada.

When do neural tube defects happen?

NTDs happen 25 to 29 days after conception, before many women even realize they are pregnant. That’s why it’s important for women to start taking folic acid supplements at least 3 months before becoming pregnant. 

How much folic acid should I take?

Most healthy women should supplement their diet with 0.4 mg (400 micrograms) of folic acid daily. You can usually find it in a daily multivitamin. 

Some women may need a higher daily supplement of up to 4 mg of folic acid. These are women who:

  • have a family history of NTDs (sibling, parent, cousin),
  • have diabetes, epilepsy, advanced liver disease or inflammatory bowel disease,
  • have had gastric by-pass surgery,
  • have a history of over-use of alcohol, or
  • have had a previous liveborn or stillborn infant with a NTD.

If you are not certain which dose you need, talk to your doctor. 

If you are already pregnant, it is a good idea to keep taking a multivitamin with folic acid throughout your pregnancy. 

Can pregnant women get tested for neural tube defects in their baby?

There are two tests available for the detection of NTDs in the second trimester of pregnancy: 

  • A blood test that measures the level of a protein called "alpha fetoprotein" or AFP in the mother's blood. This test is usually performed between 16 and 18 weeks of pregnancy. 
  • A detailed ultrasound examination of the baby's head and spine. This is usually done between 17 and 20 weeks of pregnancy. 

These tests are not harmful to the baby and will detect the majority of babies with NTDs. 

Reviewed by the following CPS committees:
Drug Therapy and Hazardous Substances Committee
Fetus and Newborn Committee

Last Updated: December 2011