This sheet talks about exposure to folic acid in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is folic acid?

Folic acid is the lab-made form of the vitamin folate (vitamin B9). Folate is necessary for making and maintaining healthy cells in your body.

Many foods naturally contain folate. These foods include dark leafy greens, asparagus, broccoli, avocado, beans, carrots, squash, nuts and citrus fruits. Folic acid is sometimes added to food to increase its nutritional value. In the United States, folic acid is added to cereal, wheat flour, corn meal, rice, and many types of bread and pasta. As of December 2018, folic acid is added to wheat flour in 80 other countries but not in the United Kingdom. Folic acid is also available as a nutritional supplement.

I take folic acid. Can it make it harder for me to get pregnant?

No. In fact, folic acid should be taken daily starting at least one month before getting pregnant.

I just found out I am pregnant. Should I stop taking folic acid?

No. Folic acid helps the baby’s brain and spinal cord to grow properly. Taking folic acid before and during pregnancy lowers the chance of a baby having a birth defect of the brain and spinal cord known as a neural tube defect. Taking folic acid might also lower the chance of other birth defects.

Does taking folic acid increase the chance for miscarriage?

No. There is no evidence that folic acid increases the chance for miscarriage.

Does taking folic acid increase the chance of having a baby with a birth defect?

No. In every pregnancy a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. Taking folic acid before and during pregnancy can lower the chance of certain types of birth defects.

Could taking folic acid cause other complications during pregnancy?

No. In fact, taking folic acid can decrease the chance of getting high blood pressure during pregnancy. Getting high blood pressure during pregnancy can cause serious complications for the mother and baby.

How much folic acid should I be taking?

Starting at least one month before pregnancy, the recommended daily amount of folic acid is 400 micrograms (mcg), or 0.4 milligrams (mg). During pregnancy, the recommended daily amount is 600-800 mcg. If you have had a baby with a neural tube defect before, the recommended daily amount of folic acid is 4000 mcg (4 mg).

You can make sure you are getting enough folic acid by eating foods high in folate or folic acid and by taking a multivitamin.

Some people have problems getting enough folate. There can be different reasons for this. Some medications can lower the amount of folic acid in the body. Diseases of the intestines can interfere with folic acid use by the body. Drinking large amounts of alcohol may cause lower folate levels in the body. Some people have a gene mutation which can prevent the body from using folic acid as it should. There are other forms of lab-made folate, such as L-methylfolate, which might work better for some people. Ask your healthcare provider if any medications that you take or other medical conditions that you have can affect the amount of folic acid in your body. Talk to your healthcare providers to learn the right dose and form of folate for you.

Can I breastfeed and take folic acid?

Yes. Folic acid is naturally found in the breast milk of women who are well-nourished. While breastfeeding, it is recommended that you consume 500 mcg (0.5 mg) of folic acid every day. Your baby gets folic acid from your milk, so it is important that you have enough folic acid while breastfeeding. Talk to your healthcare provider for all of your breastfeeding questions.

What if the father of the baby takes folic acid?

Some studies have suggested that folic acid is needed to make healthy sperm. Most men get adequate folate from their diet alone, but if your partner is concerned about his intake, he could talk to his healthcare provider about taking a multivitamin with the recommended amount of folic acid for men which is 400 mcg/day (0.4 mg/day). For more information on paternal exposures in general, please see the Paternal Exposures fact sheet at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Selected References:

• Aslinia, F., et al. 2006. Megaloblastic anemia and other causes of macrocytosis. Clin Med Res. 4(3): 236–241.
• Dervla K, et al. 2012: Use of Folic Acid Supplements and Risk of Cleft Lip and Palate in Infants: A Population-based Cohort Study. Br J Gen Pract. 62(600): e466–e472.
• Pittschieler S, et al. 2008. Spontaneous abortion and the prophylactic effect of folic acid supplementation in epileptic women undergoing antiepileptic therapy. J Neurol. 255(12):1926-31.
• Toriello, HV. 2011. Policy statement on folic acid and neural tube defects. Genet Med. 13(6):593-6.
• Young SS, et al. 2008. The association of folate, zinc and antioxidant intake with sperm aneuploidy in healthy non-smoking men. Hum Reprod. 23 (5): 1014-1022.
• Wang G, et al. 2016. Association between maternal pregnancy body mass index and plasma folate concentrations with child metabolic health. JAMA Pediatr. 170(8): e160845.
• Wen, S et al. 2016. Folic acid supplementation in pregnancy and the risk of pre-eclampsia—a cohort study. PLoS ONE 11(2): e0149818
• Wong WY, et al. 2002. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 77:491-8.