Folic acid and your pregnancy
Every year in Australia, about 50 babies are born with spina bifida.
Neural tube defects (NTDs) occur in the early stages of pregnancy during the initial development of the brain and spinal cord. Most NTDs can be detected by routine antenatal testing, including blood tests and ultrasound scans. Types of NTDs include spina bifida, encephalocele and anencephaly. NTDs result from the spinal cord or bones of the skull not closing properly during development.
The good news is that up to about two-thirds of NTDs can be prevented if expectant mothers consume enough folate (also referred to as folic acid) in their diets, before and during the first 3 months of their pregnancy.
Spina bifida means ‘split or divided spine’, and causes a baby to be born with exposed nerves and damage to the vertebrae. Spina bifida is one of the Western world’s most common birth defects. The effects of the condition are permanent, and may include incontinence, paralysis, and loss of sensation and mobility.
What is folate?
Folate is the naturally-occurring form of a water-soluble B group vitamin. Folic acid is a synthetic form of the vitamin used in supplements (tablets) or added to foods such as breads, cereals and some drinks.
Folate is used within the body for cell regeneration and growth. Pregnant women need about one and half times as much as other adults. Evidence suggests that adequate folate has more benefits to pregnant women than preventing NTDs and may also reduce the risk of early deliveries and low birth weight babies.
How much folate is enough?
The National Health and Medical Research Council recommends that pregnant women increase their intake of dietary folate to 600 micrograms (0.6 mg) a day, to cover their own needs and those of the baby. As well as the folate that occurs in a varied diet, it is also recommended that women begin taking a folic acid supplement of 400 micrograms (0.4 mg) a day for one month before conceiving and during the first 3 months of pregnancy to reduce the risk of having a baby with a NTD.
If you are having trouble eating during the early stages of pregnancy due to morning sickness your doctor may advise you to take a supplement containing 600 micrograms (0.6 mg) of folic acid.
Those who have a family history of neural tube defects may also need to take a higher dose of folic acid. Your doctor can advise you on this.
How do I increase my folate intake?
There are 3 ways to increase your folate intake:
- include folate-rich foods in your diet;
- include foods fortified with folic acid in your diet; and
- take daily folic acid supplements that contain at least 400 micrograms (0.4 mg) of folic acid.
Note that multivitamin supplements may not contain enough folic acid for pregnancy and many have only very small amounts of the vitamin.
Which foods are rich in folate?
- Green, leafy vegetables, such as watercress, spinach, lettuce, Asian greens and silverbeet (the word 'folate' is derived from 'foliage').
- Vegetables, such as peas, broccoli, Brussels sprouts, asparagus, cauliflower, sweet corn and red capsicums.
- Oranges, bananas, apples and berries.
- Legumes, such as soy beans, chick peas and split peas.
- Peanuts and sunflower seeds.
- Yeast extract, for example, Vegemite or Marmite.
- Foods with added folic acid, such as breads (folic acid must be added to most bread flour in Australia) and cereals.
Folic acid fortification of foods has been permitted in Australia since June 1995. Because of a low uptake by many Australian food companies, in 2009, it became mandatory for folic acid to be added to wheat flour used for bread making. Organic bread and bread made from cereals grains other than wheat do not have to add folic acid, but most breads in Australia are now sources of folic acid.
Many breakfast cereals also have added folic acid and it may be added to some drinks. These foods can generally be identified through a health claim on the package initiated by Food Standards Australia New Zealand.
Liver and liver products such as pate are high in folate, but are not recommended for pregnant women due to the risk of developing listeriosis, a disease which can be fatal to an unborn baby.
Talk to your doctor
If you are planning to get pregnant, or are concerned about your folate intake, talk to your doctor or health professional. All women of reproductive age are encouraged to increase their folate levels, particularly if they are planning a pregnancy.
Last Reviewed: 01/08/2015
Australian Government Department of Health and Ageing and NHMRC. Nutrient Reference Values for Australia and New Zealand, including Recommended Dietary Intakes, 2006. Endorsed 9 September 2005.
Spina bifida occulta
Spina bifida occulta is a split in the spine, hidden by the skin. In the majority of cases, it will cause no problems.
Continence in spina bifida: bladder and bowel
Issues surrounding bladder or bowel continence are a concern for many people with spina bifida.
Eating well in pregnancy
Eating a nutritious and varied diet in pregnancy is the best way of caring for yourself and your baby.
Alpha-fetoprotein (AFP) tests in pregnancy
An alpha-fetoprotein (AFP) test is a blood test that can show whether your fetus has signs of some birth defects, in particular, spina bifida (a type of neural tube defect) or chromosome abnormalities.
Whether you are thinking about having a baby for the first time or have been pregnant before, with a little planning you can give yourself the best chance of a healthy pregnancy and baby.