Folic Acid (Vitamin B9): When to Start, How Much and Until When?

Thinking of growing your family? Even before the pregnancy test, one simple step counts: taking folic acid. This B vitamin plays a part in closing the neural tube, the early form of your future baby's brain and spinal cord. And this stage happens in the very first weeks, often before you know you are pregnant.

Why it matters, when to start, how much, until when, which foods at our markets contain it, which supplement to choose: here are the answers from health authorities (WHO, HAS, NHS, CDC). They do not replace the advice of your doctor, your midwife or your pharmacist.

Why is folic acid important before and during pregnancy?

Folates, or vitamin B9, play a role in the development of the embryo's nervous system, particularly in the closure of the neural tube (Santé publique France). When this tube does not close properly, the child can be born with a serious malformation of the brain (anencephaly) or of the spinal cord (spina bifida), points out ANSES, the French food safety agency.

Timing explains everything. According to the US CDC, these defects occur in the first weeks of pregnancy, often before a woman knows she is pregnant. ANSES insists: adequate intake is needed from the very first day of pregnancy, whether it was planned or not.

Folate or folic acid: what is the difference?

• Folates are the natural form of vitamin B9, found in food.
• Folic acid is the form used in supplements and fortified foods (CDC).
• The recommended doses (400 µg a day) apply to folic acid taken as a supplement.

When should you start taking folic acid?

As early as possible, as soon as you plan a baby. Health authorities agree on the principle:

• WHO: as soon as you start trying to conceive.
• HAS (France): as soon as you wish to become pregnant, with a prescription at the pre-conception appointment.
• ACOG (United States): at least one month before conception.
• NHS (United Kingdom): if you did not take it before, start as soon as you find out you are pregnant.

Why so early? You never know exactly when conception will happen. Starting from the first attempts means you have adequate intake at the precise moment the neural tube forms, without waiting for a missed period.

In practice, the right moment is often when you stop your contraception. Take the opportunity to have a pre-pregnancy check-up with your doctor: vaccines, current treatments, blood test. If you track your cycle, our article on ovulation and fertile days will help you spot the right window.

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How much folic acid should you take?

The recommended dose for the vast majority of women is 400 micrograms (µg) a day, or 0.4 mg. The same figure comes up everywhere:

When is a higher dose needed?

Some women have a higher risk of a neural tube defect. Their doctor then prescribes a much higher dose, to be started before conception. According to the NHS, this applies if:

• you or the baby's biological father have a neural tube defect, or there is a case in your family;
• a previous pregnancy was affected by a neural tube defect;
• you have diabetes;
• you take medicine for epilepsy;
• you take antiretroviral medicine for HIV.

The HAS also mentions a history of spina bifida, diabetes and anti-epileptic treatments. This dose is taken only on prescription. If you are in one of these situations, talk to your doctor as soon as you plan a pregnancy, without stopping or changing your treatments yourself.

Until when should you take folic acid?

Supplementation continues until 12 weeks of pregnancy according to the WHO and the NHS, that is, the 12th week of amenorrhoea (counted from the first day of your last period) according to the HAS. In practice, this covers roughly the first three months of pregnancy. Note the start date in your pregnancy record: at the first-trimester appointment, your doctor will tell you whether to stop or continue, and in what form.

And after that? Advice differs from country to country. The WHO recommends a daily supplement combining iron and folic acid for all pregnant women, to prevent anaemia in the mother, infection after the birth, low birth weight and premature birth. The British NHS, on the other hand, only advises iron if your blood iron level becomes low. In Morocco, follow your doctor's advice, as they decide based on your test results: see our article on anaemia in pregnancy.

If pregnancy is taking a while, carry on every day for as long as you are trying: the CDC recommends 400 µg a day for all women who could become pregnant.

Which foods are rich in folate in Morocco?

Good news: our cooking is rich in folate. ANSES puts pulses and leafy green vegetables at the top of the list; Santé publique France adds, among others, citrus fruit, bananas, melon, avocado, nuts and eggs.

Two precautions. Liver is rich in folate, but not advised during pregnancy because it provides too much vitamin A (NHS). And carefully wash raw vegetables, salads and fresh herbs such as parsley or coriander. More ideas in our article on eating well during pregnancy.

A folate-rich day, Moroccan style

• Breakfast: barley bread, a well-cooked egg, an orange.
• Lunch: lentils with vegetables or pea tagine, green salad.
• Afternoon snack: a few almonds and a banana.
• Dinner: harira with chickpeas and lentils, sautéed spinach.

These foods are valuable, but health authorities recommend the supplement in addition to a varied diet: one does not replace the other during this key period.

Which folic acid supplement should you choose?

There are two options, to choose with your doctor or pharmacist:

• A folic acid-only tablet, often prescribed when you are planning a pregnancy.
• A pregnancy multivitamin that provides 400 µg of folic acid, along with other vitamins and minerals.

Our pregnancy and breastfeeding supplements aisle offers the Pregnacare range. According to the manufacturer, Pregnacare Conception is aimed at the time when you are trying for a baby, and Pregnacare Original at pregnancy. According to the formulations published by the manufacturer (vitabiotics.com), each provides 400 µg of folic acid per tablet, with beta-carotene and no retinol. They also contain iron, iodine and vitamin D, in amounts that differ from one product to another: check the label and show the box to your doctor or pharmacist before you start, especially if you have already been prescribed another treatment.

Before buying, check:

• the amount of folic acid: 400 µg a day, unless prescribed otherwise;
• that it contains no retinol, which the NHS advises against during pregnancy;
• that you are not combining two products that provide the same vitamins;
• the leaflet: when to take it and how many tablets a day.

For vitamin D, iron or iodine, read our full guide: which vitamins to take during pregnancy.

From the shop

Supplements from conception to breastfeeding

The Pregnacare range, to take after advice from your doctor or pharmacist.

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Products sold by La Maison du Bébé, publisher of this magazine. Please check price and availability on the product page.