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 serious birth problems known as neural tube defects, such as:

• spina bifida — spine and spinal cord don't develop properly
• anencephaly — major parts of the brain, skull and scalp do not develop
• encephalocele — bulging of brain tissue or its covering membranes through a defect in the skull

Neural tube defects 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 3 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. The following are good sources of natural folate:

• vegetables (broccoli, peas, cabbage, cauliflower, English spinach, radish, lettuce, kale, sweet corn)
• fruit (avocado, grapefruit, oranges, berries, bananas)
• legumes (chickpeas, soya beans, lima beans, red kidney beans, lentils, haricot beans)
• eggs (in Australia)
• nuts
• juices (many apple and orange juices)
• yeast spreads such as Vegemite

Folate can be easily destroyed by cooking as it dissolves in water. It is best to lightly cook vegetables or wash them and then eat them raw. Microwave or steam cooking is best.

In Australia, all flour must contain folic acid when it is used for making:

• bread (except organic bread)
• rolls
• bagels
• English muffins
• flat breads made with yeast

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.

Learn more about how to read food labels.

When should I start taking folic acid supplements?

Your body needs a higher amount of folic acid than usual to support your pregnancy. You should start taking a daily folic acid supplement:

• at least one month before you actively start trying to get pregnant
• 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 without a prescription at most pharmacies and supermarkets, and through your doctor in different doses.

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How much folic acid do I need?

Generally, when trying to get pregnant and 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. 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.

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How will I know if I need a higher 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 (5 milligrams (mg)) of folic acid daily until you are 12 weeks pregnant. Your doctor will consider different factors when recommending a dose of folic acid, including if you:

• have a neural tube defect (or your partner has one)
• have a family history of neural tube defects (or your partner's family has a history)
• had a previous pregnancy affected by a neural tube defect
• have diabetes
• have a body mass index (BMI) greater than 30
• have a medical condition that increases your chance of not absorbing nutrients well
• take medicine for epilepsy or other medicines known to affect the absorption of folic acid

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 can refer you for a blood test to measure your level of folate.

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 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 13 11 26. You can call 24 hours a day, 7 days a week from anywhere in Australia.

To learn more about folate during pregnancy:

• Eat For Health has nutrient values for folate consumption at different stages of your life.
• Read about neural tube defects on the Sydney Children's Hospital website.
• Find ideas for folate-rich meals on the Jean Hailes website.
• The Royal Women's Hospital Melbourne has information on preparing for a healthy pregnancy.

Information for Aboriginal and/or Torres Strait Islander peoples

The Australasian Diabetes in Pregnancy Society has a factsheet on folate during pregnancy.

Learn about healthy eating during pregnancy from the Queensland Government.