At a glance:
- Folate (vitamin B9) protects against fetal neural tube defects from the very first weeks of pregnancy, when you may not yet know you are pregnant.
- WHO recommends that women planning a pregnancy take at least 400 µg of folic acid daily, starting one month before conception.
- The best food sources are spinach, lentils, broccoli and citrus fruits, but a supplement is usually necessary because only about 50% of the folate in food is absorbed.
- Folic acid (a synthetic supplement) and folate (found naturally in food) are not quite the same — the active 5-MTHF form is better suited to people with certain genetic variations.
Folate intake when planning a pregnancy is one of the most important aspects of nutrition that modern science has repeatedly highlighted. This water-soluble vitamin B9 is involved in DNA synthesis and cell division — processes that are particularly critical in early fetal development. Adequate folate stores before and during early pregnancy can directly influence your child’s lifelong health.
Why is folate so important when planning a pregnancy?
The fetal neural tube closes by approximately day 28 after conception — a time when many women do not yet know they are pregnant. Folate stores are crucial at this stage of development: low levels significantly increase the risk of neural tube defects such as spina bifida and anencephaly.
In a Hungarian randomized controlled trial, Czeizel and Dudás (1992) showed that folic acid supplementation around the time of conception significantly reduced the incidence of neural tube defects compared with the control group (Czeizel & Dudás, 1992). Similar results were found in a larger study conducted in China, where a daily intake of 400 µg of folic acid reduced the incidence of neural tube defects in high-risk regions by up to 85% (Berry et al., 1999).
Nutrition supports the body as an interconnected system — as the article pH and healthy eating also explains, the body’s acid–base balance affects nutrient absorption, including folate bioavailability.
How much folate do you need before and during pregnancy?
The World Health Organization (WHO) recommends that all women planning a pregnancy take at least 400 micrograms (µg) of folic acid daily, starting at least one month before a planned pregnancy. During pregnancy, the recommended amount rises to 600 µg daily, and during breastfeeding it is 500 µg (WHO, 2016).
Daly et al. (1995) showed that a red blood cell folate concentration below 150 nmol/l is associated with a significantly higher risk of neural tube defects. For optimal protection, adequate folate stores must be established at least 12 weeks before pregnancy — highlighting the importance of early planning.
Unlike fat-soluble vitamins, folate is not stored in the body for long periods, so regular daily intake is essential. General nutrition principles, such as those discussed in Post-workout nutrition – I and Post-workout nutrition – II, emphasize that an adequate daily intake of micronutrients supports all bodily processes — including reproductive health.
Which foods contain the most folate?
The following foods are rich in naturally occurring folate:
- Green leafy vegetables — spinach, lettuce, broccoli, Brussels sprouts
- Legumes — lentils (~180 µg / 100 g cooked), chickpeas, black beans
- Citrus fruits — oranges, grapefruit, mandarins
- Whole-grain foods — whole-grain bread, rolled oats
- Nuts and seeds — sunflower seeds, peanuts
However, only about 50% of the folate in food is absorbed on average, compared with up to 100% of synthetic folic acid from supplements taken on an empty stomach (Greenberg et al., 2011). This means that diet alone usually cannot provide the optimal levels needed when planning a pregnancy.
Nutrition also affects hormonal balance more broadly — the article Nutrition and testosterone explains how different nutrients influence the body’s hormonal regulation, which is also important for fertility.
What is the difference between folate and folic acid — and which should you choose?
These two terms refer to different forms of the same vitamin:
- Folate — naturally occurring vitamin B9 found in foods
- Folic acid — the synthetic form used in supplements and fortified foods
- 5-MTHF (5-methyltetrahydrofolate) — the most active form, which the body can use directly
Enzymes in the body must convert folic acid into active 5-MTHF. About 10–15% of the population carries a variant of the MTHFR gene (C677T) that significantly slows this conversion. For these people, a supplement containing the active 5-MTHF form may be more effective (Greenberg et al., 2011). However, the decision to choose an alternative form should be made with a healthcare professional.
The practical recommendation for most women planning a pregnancy is to start with a standard folic acid supplement (400 µg daily), which has been widely studied and has strong evidence supporting its effectiveness. You can find more information on WHO recommendations in the WHO guideline on antenatal care.
References
- Czeizel AE, Dudás I. (1992). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 327(26):1832–5. PMID: 1307234
- Berry RJ, Li Z, Erickson JD, et al. (1999). Prevention of neural-tube defects with folic acid in China. China-U.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med. 341(20):1485–90. PMID: 10559448
- Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM. (1995). Folate levels and neural tube defects. Implications for prevention. JAMA. 274(21):1698–702. PMID: 7474275
- Greenberg JA, Bell SJ, Guan Y, Yu YH. (2011). Folic acid supplementation and pregnancy: more than just neural tube defect prevention. Rev Obstet Gynecol. 4(2):52–9. PMID: 22229057
- World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO.
Frequently asked questions
When should you start taking folic acid before pregnancy?
WHO recommends starting folic acid supplementation (400 µg daily) at least one month before planned conception and continuing until at least the end of the first trimester, because the neural tube closes as early as week 4 of pregnancy.
Can I get enough folate from food alone?
Only about 50% of the folate in food is absorbed, making it difficult to achieve optimal levels for pregnancy planning through food alone. A supplement is also recommended for most women.
Is folic acid safe in large amounts?
The European Food Safety Authority (EFSA) has set an upper limit for folic acid of 1000 µg daily for adults. The standard dose when planning a pregnancy (400 µg) is considered completely safe, with minimal side effects.
What does an MTHFR gene variant mean for folic acid intake?
People with the MTHFR C677T variant convert folic acid into its active form, 5-MTHF, more slowly. A doctor may recommend that they use the more active 5-MTHF form, but this decision should be made together with a healthcare provider.
Does folate only affect neural tube development?
No — folate is also important for placental formation, overall fetal growth and the prevention of anemia, and is associated with a lower risk of several pregnancy complications, including preterm birth.
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