Folate and folic acid are important for pregnancy because they can help prevent birth defects known as neural tube defects, such as spina bifida.

Folic acid is one of the B vitamins needed for healthy growth and development. It is known as “folate” when it is found naturally in food, such as green leafy vegetables, and “folic acid” when it is added to food, such as bread and breakfast cereals, or used in supplements.

About 1 in 1,000 babies in Australia are born with a neural tube defect such as spina bifida.

Spina bifida is one of the most common birth defects. It occurs in the early weeks of pregnancy, when the brain and spinal cord are forming.

Most cases of neural tube defects can be prevented if you have enough folic acid before and during early pregnancy.

You can get enough folic acid by eating folate-rich foods and taking a supplement.

Folic acid supplement

These medicines are available in Australia without a prescription from pharmacies and through your doctor in different doses. Some women need more folic acid than others. Talk to your doctor about the right dose of folic acid for you.

In general, when trying to conceive or in the early months of pregnancy, you will want to look for a supplement that contains at least 400 micrograms of folic acid. These will generally be supplements that contain only folic acid or special pregnancy supplements. Multivitamin supplements usually do not contain enough folic acid.

The best way to ensure that you get enough folic acid is to take a daily folic acid supplement for at least 1 month before conception and up to 3 months after conception. You do not need to take a folic acid supplement after that.

Foods rich in folate

Many foods are naturally rich in folate, but folic acid is water soluble and easily destroyed by cooking. It is best to cook vegetables a little or eat them raw. It is best to use a microwave or steam cooking.

The following are good sources of natural folic acid:

• Vegetables (broccoli, brussels sprouts, cabbage, cauliflower, English spinach, green beans, lettuce, mushrooms, parsnips, sweet corn, zucchini)
• Fruit (avocado, grapefruit, orange)
• Legumes (chickpeas, soybeans, kidney beans, red kidney beans, lentils, kidney beans)
• egg
• nuts
• Juices (many apple and orange juices).

Voluntary fortification of many foods with folate has been permitted in Australia since June 1995. Mandatory fortification with folic acid for all flours used to make bread (except organic bread) began in 2009. Three slices of bread (100 g) contain an average of 120 micrograms of folic acid.

Higher dose of folic acid

Some women are at an increased risk of developing a pregnancy affected by a neural tube defect and are advised to take a higher dose (5 mg) of folic acid each day until they are 12 weeks pregnant. Women are at increased risk if:

• They or their partners have a neural tube defect
• They or their partners have a family history of neural tube defects
• Have had a previous pregnancy affected by a neural tube defect
• They have diabetes
• Have a body mass index (BMI) greater than 30
• They have a risk of not absorbing nutrients well

In addition, women who are taking anti-epileptic medicines should consult their doctor for advice as they may also need to take a higher dose of folic acid.

If any of the above apply to you, talk to your doctor as he may prescribe a higher dose of folic acid. Your doctor or midwife may also recommend additional screening tests during pregnancy.