What is folate and folic acid?

Folate (vitamin B9) is a B-group vitamin needed for healthy growth and development. It is known as 'folate' when it is found naturally in food, such as leafy green vegetables, fruits, and legumes. It is called 'folic acid' when it is added to food, such as bread and breakfast cereals, or used in dietary supplements.

Why is folate important for pregnancy?

Folate and folic acid are important for pregnancy because they can help prevent birth defects known as neural tube defects, such as spina bifida. Spina bifida is one of the most common birth defects. It can happen in the first weeks of pregnancy, when the brain and spinal cord are forming.

Most cases of neural tube defects can be prevented if you have enough folate (or folic acid) before and during the first three months of pregnancy. You can get enough folate by eating folate-rich foods and taking a supplement.

Which foods contain folate?

Many foods naturally have folate, but folate can be easily destroyed by cooking as it dissolves in water. It is best to lightly cook vegetables or eat them raw. Microwave or steam cooking is best.

The following are good sources of natural folate:

• vegetables (broccoli, brussels sprouts, cabbage, cauliflower, English spinach, green beans, lettuce, mushrooms, parsnip, sweet corn, zucchini)
• fruit (avocado, grapefruit, oranges, berries, bananas)
• legumes (chickpeas, soya beans, lima beans, red kidney beans, lentils, haricot beans)
• eggs
• nuts
• juices (many apple and orange juices)
• Vegemite

In Australia, all flour used for making bread (except organic bread), rolls, bagels, English muffins, and flat breads made with yeast must contain folic acid. It can also be found in some breakfast cereals. Three slices of bread (100g) contain an average of 120 micrograms of folic acid. You can check the food label of any bread product made in Australia to check if it contains folic acid (sometimes listed as folate) in the ingredients.

When should I start taking folic acid supplements?

You should start taking a daily folic acid supplement at least one month before you actively start trying to get pregnant and throughout your first trimester. If you haven't taken folic acid supplements before pregnancy, be sure to start as soon as you can, once you know you are pregnant.

Folic acid supplements are available in Australia over the counter from pharmacies and supermarkets, and through your doctor at varying doses.

How much folic acid do I need?

Generally, when trying to get pregnant or in the first few months of pregnancy, you will need a supplement that contains at least 400 micrograms (sometimes written as mcg or µg) of folic acid.

In Australia, most folic acid supplements come in a 500mcg daily dose. These are available as supplements that contain only folic acid, or special pregnancy supplements that may include other nutrients as well.

There are many multivitamins that may contain folic acid, and it's important not to double up on some vitamins, so check with your doctor that you are getting the recommended dose.

Some people will need more folate than others. Talk to your doctor about what dose is right for you.

How will I know if I need a high dose of folic acid?

Some pregnancies have a higher risk of being affected by a neural tube defect. In these situations, your doctor will recommend taking a higher dose (5mg) of folic acid each day until you are 12 weeks pregnant. Your doctor will consider your risk factors when recommending a dose of folic acid, for example, if:

• you or your partner have a neural tube defect
• you or your partner have a family history of neural tube defects
• you had a previous pregnancy affected by a neural tube defect
• you have diabetes
• you have a body mass index (BMI) greater than 30
• you have a medical condition that increase your chance of not absorbing nutrients well
• you take medicine for epilepsy

If any of the above apply to you, talk to your doctor, as they can check if you are at risk and prescribe a higher dose of folic acid if you need one.

Your doctor or midwife may also recommend additional screening tests during your pregnancy.

What happens if I take too much folic acid?

If you are taking a standard daily dose of folic acid and you accidentally have an extra one, there is usually no cause for concern.

Folic acid, like other B-group vitamins, is water-soluble. This means the extra folic acid your body doesn’t absorb will pass naturally out of your body when you urinate.

However, if you think you’ve been taking too much folic acid, speak to your doctor or call the Poisons Information Centre on 13 11 26.

Resources and support

• Speak to your doctor if you are planning a pregnancy, or if you think you might be pregnant.
• Family Planning NSW Talkline also provides a free information service, you can call 1300 658 886 (Monday to Friday, 8:00am-8:00pm) or visit your nearest Family Planning NSW clinic.
• If you think you may have taken too much (overdose) of folic acid or a multivitamin, call Poisons Information Centre on 131 126. You can call 24 hours a day, 7 days a week from anywhere in Australia.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.