Get Primed for Pregnancy with Extra Folic Acid

January 27, 2014
For women planning to get pregnant, folic acid is no ordinary vitamin. Research shows that taking folic acid supplements before conception and during pregnancy may lower the risk of having a baby with a neural tube birth defect.

Between two and four of every 1,000 babies born in Canada have neural tube defects that impact the spine or brain – these include spina bifida and anencephaly.  A neural tube defect is where the spine or base of the brain does not form properly.

Dr. Karen Buhler, a family physician at BC Women’s, explains that folic acid so important because it impacts cell division in fostering healthy development of the spine and brain: “This is one of the few vitamins that has been proven to make a big difference in outcomes for babies. There is strong evidence that taking extra folic acid as a supplement can make a significant difference.”

Before you get pregnant

The key is taking folic acid early enough to make a difference.  As the baby’s neural tube development happens in the first six weeks of gestation, when most women don’t realize they are pregnant, a pre-conception folic acid supplement is ideal.  However, the multi-vitamins that many people already include in their morning routine do not contain enough folic acid, and it’s difficult to get the recommended dose by diet alone.

As a busy maternity care provider, Buhler offers some practical advice about getting the folic acid that you need. First of all, if you want to get pregnant,  it’s important to note Canada’s Centre for Disease Control and Prevention now recommends thinking about pregnancy planning and visiting your doctor before you get pregnant.

“I don’t see enough women who do that yet,” Buhler says. “Women may not know that there are things that can be done to improve their health before they get pregnant: One of them is taking folic acid.”

Your family doctor will also know if you are at increased risk of giving birth to a baby with a neural tube defect because of family history or existing health circumstances that may cause a folic acid deficiency. For example, obesity, smoking, digestive problems or certain medications can impact the body’s ability to absorb folic acid.

BC’s Maternity Care Pathway, which provides maternity care providers with recommendations for routine care during pregnancy, advises that most women benefit from a folic acid supplement containing 0.4 to 1 mg daily, but women considered to be at greater risk should take 5 mgs a day.

Hints for taking folic acid

As an experienced maternity care physician, Buhler advises her patients to take daily supplements containing at least one mg of folic acid. She also has some helpful tips for women who find it difficult to get the daily dose.

“Folic acid can stay in your body for several days to weeks, so for anyone who finds it hard to take their vitamin every single day, even one 5-mg tablet of folic acid a week is beneficial,” she says.

“Most women are nauseated in the first three months of pregnancy. Since it is the iron in the multivitamin that aggravates nausea, I often recommend that they can try taking folic acid by itself.”

In her practice, she also reassures women who are already pregnant and worried about the lost opportunity to take folic acid pre-conception.

“Start taking folic acid as soon as you find out that you are pregnant.  This also has benefit.  The chance of having a baby with a neural tube defect is relatively small, so focus on having a healthy pregnancy.”
Women who may benefit from higher doses of folic acid (5 mg daily) in pregnancy are: 
Women with:

• A higher risk of neural tube defects due to genetic or family history
• Digestive disorders that can affect absorption of nutrients, such as inflammatory bowel disease
• Obesity (with a  Body Mass Index or BMI higher than 35)
• Diabetes
• Difficulty taking supplements regularly

Women who:

• Take anti-epileptic drugs
• Take folate antagonists (drugs that impact how folic acid works) such as methotrexate or sulphonamides
• Smoke tobacco
• Belong to higher risk ethnic groups, e.g. Sikh, Celtic, Northern Chinese

(The source for the above information about women who may benefit from higher doses of folic acid is an article from the Motherisk Program at the Hospital for Sick Children published in the Canadian Family Physician, April 2012.)


• The Motherisk  Website - a Canadian resource with useful information for pregnant women.
• The Perinatal Services Maternity Care Pathway (for care providers) and Women’s Health Pregnancy Passport  (for women)
• The U.S. Centers for Disease Control:  Show Your Love: Steps to a Healthier Me and Baby to Be
• Dietitians of Canada online tool for calculating your Body Mass Index (BMI)

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The content provided in Women’s Health eNews is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical conditionBC


Alison (3 years ago)
Thank you to Dr. Buhler for talking about the importance of getting enough folic acid pre-pregnancy and during gestation. I have visited my OB and written him asking him to screen his patients for diseases that cause cause inadequate nutrient absorbtion. I was an undiagnosed celiac during my last preganancy. I believe my child suffered some helath issues due to this, although nothing can be proven.My OB listened to what I had to say and I believe he has changed his screening practice as a result of our talk. I think it would be a good idea for all newly pregnant women to have folic acid levels checked and if celiac is at all suspected in the patient, then a simple blood test for the anti TTG. I am so happy to hear that the message about the importance of folic acid levels is getting out to the general public.Thank you. Alison (mother of 4)

Alison(3 years ago)
I just read my post and am sorry for some of the typos. One of my kids was talking to me while I was trying to write my post.

Dr K Buhler(3 years ago)
Thank you for your personal comments Alison. You bring out a few important points and questions. The research about the benefit of higher doses of folic acid for some women is relatively new and has been highlighted by Motherrisk in the past year in a memo to care-providers and the public. Measuring folic acid blood levels in all women is not necessarily helpful nor acceptable to women.

There are more people being diagnosed with Celiac disease in recent years and the reason for this is unclear. Unfortunately making a diagnosis of celiac disease is not as simple as having a positive blood test: TTG. Women who suspect they may have a disorder that leads to poor absorption should see a family doctor long before getting pregnant, and should bring this to the attention of their maternity care provider: family doctor, midwife or obstetrician.

Alison(3 years ago)
Thank you, Dr. Buhler, for your comments. I am really pleased that you took the time to address what I said.

My celiac disease was confirmed by having a duodenal biopsy done, but it was the elevated level of 24 for my anti TTG bloodwork that suggested I may have a sensitivity to gluten. That lead to my biopsy which confirmed celiac.I suppose that the point I was trying to make, but didn't finish, is that a simple blood test might alert a physician to look further.

I absolutely agree that it is better to find out about this condition before pregnancy. My understanding, is that I've carried the celiac gene my whole life, but it only activated and started to cause mild symptoms prior to my last pregnancy. My symptoms were so vague, that my disease wasn't confirmed until my baby was over 2yrs old.

Thanks again for helping to get the newest information out to women. I am sure many will benefit. Best regards.

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