What Happens if You Don't Take Folic Acid During Pregnancy?

Taking folic acid can help with fetal development, but what happens if you don't take folic acid during pregnancy? Read on to learn more. 

By OBGYN and fertility specialist Dr. Kenosha Gleaton

There are a lot of important vitamins and minerals that are especially important during pregnancy. Folic acid is no exception and should be taken when trying to conceive and during pregnancy. Let’s talk about why folic acid is so important. 

Folic acid and folate overview

Folate, also known as B9, is a naturally occuring vitamin found in some vegetables, fruits, nuts, and legumes. Folic acid is a synthetic or man-made form of folate that is often found in vitamins and fortified food products. Folate is a necessary nutrient for red blood cell production, DNA maintenance, cell division, fetal development, and can even benefit sperm health (read more about folate for men’s health). Most commonly, folate is suggested to those trying to conceive (TTC) or pregnant to help reduce the risk of neural tube defects. 

Some supplements may contain folate, methylfolate, folic acid, or MTHF folate. Essentially, MTHF folate or methylfolate is the form of folate that is the easiest for the body to absorb and use. Read more about MTHF folate vs folic acid.

How much folic acid do I need?

Most adults should be consuming at least 400 mcg of folate every day. In the United States, this daily recommended amount is reached by most healthy adults through the diet alone. There are some groups that may need additional folate supplementation, including those trying to conceive or pregnant (at least 600 mcg/day) and those lactating (500 mcg/day). Natalist Prenatal Daily Packets contain 800 mcg of folate along with other vital nutrients. 

Some groups are also at an increased risk of having low folic acid levels, including:

• Females aged 14 to 30

• Black women

• People with eating disorders

• People with alcohol use disorders

• Those with the MTHFR gene variant

• People with digestive disorders, including IBS and celiac disease

• People taking medications for epilepsy and ulcerative colitis. 

Check out the Natalist blog to learn about what supplements to take for pregnancy. 

Effects of low folate levels during pregnancy

Folate supplementation during pregnancy is recommended by many healthcare professionals, as well as the National Institutes of Health, The American College of Obstetrics and Gynecology, and the Centers for Disease Control and Prevention. Folate plays a vital role in early fetal development, and without folate supplementation, you may be at an increased risk of multiple complications.

Increased risk of neural tube defects

Neural tube defects (NTDs) are birth defects related to the neural tube, which is the central nervous system (the brain and spinal cord) during the first few weeks of gestation. If the neural tube isn’t able to close completely, part of the brain, skull, spinal cord, and back bones may be impacted. 

The neural tube is closed completely four weeks from conception, leaving a fairly short time period for the preventive effects of folate supplementation to kick in. In order to encourage NTD prevention, the United States has been adding folic acid to grain products since 1998. Most data shows a 28% decline in incidence of NTDs, supporting the benefits of folic acid in the diet prior to and during early fetal development. 

This is one of the reasons that folic acid and prenatal vitamin supplements are recommended for everyone of reproductive age, especially those actively TTC. 

Spina Bifida

Spina bifida is a neural tube defect that occurs in the first few weeks of pregnancy. It’s estimated that about 1,400 babies are born with spina bifida every year in the United States. There are a few types of spina bifida that may occur, all of which are caused by the incomplete closing of the neural tube during development. This will often result in damage to the spinal cord and spinal nerves and may cause severe physical and intellectual disabilities. 

Anencephaly

Anencephaly is another type of neural tube defect that is estimated to occur in about one out every 4,600 babies born in the United States. Babies born with anencephaly are born without parts of the skull, forebrain, and cerebrum, which is the part of the brain responsible for cognition and coordination. This is a fatal condition, sometimes resulting in miscarriage, or the baby passing away hours or days after birth. 

Premature birth and low birth weight

Low levels of folate during pregnancy has been associated with an increased risk of premature birth and low birth weight. Premature birth is characterized as birth before the 37th week of pregnancy and may result in complications with the respiratory system, heart, brain, and other body systems. Low birth weight has been defined as a weight at birth less than five and a half pounds and may increase the risk of neonatal mortality and morbidity. 

Anemia 

Folate is a necessary nutrient for red blood cell production. Without enough folate in the diet, folate-deficiency anemia can occur. Pregnant women are at a higher risk of developing folate-deficiency anemia due to shared nutrients with the fetus and a slower absorption speed. Anemia may lead to dangerous complications, including neural tube defects and leg paralysis. 

Symptoms of low folate levels

According to the National Institutes of Health, a folate deficiency in the United States is rare due to the high amount of fortified foods. Pregnant women are still at risk of complications without seeing the symptoms of a folate deficiency.  Be sure to speak with your healthcare provider for guidance on whether you’re getting enough folate, and keep an eye out for folate deficiency symptoms, including:

• Muscle weakness

• Decreased appetite

• Fatigue

• Mouth sores

• Memory loss

• Confusion

• Weight loss

• Pale skin

• Reduced sense of taste

• Irritability

• Tender, smooth, or red tongue

Can you take too much folic acid?

There is an established upper limit for folate that should not be exceeded. For most nonpregnant adults 19 years and older, this limit is 1,000 mcg/day. Large amounts of folate can be dangerous, as it may hide a deficiency in vitamin B12. Although symptoms of a B12 deficiency may not be present, nerve damage and other complications may occur while being masked by high folate levels. Some research suggests that high folate levels may worsen symptoms of B12 deficiency and may increase the risk of some cancers. Be sure to talk with your healthcare provider about the supplements and medications you’re taking. 

Key Takeaways

• Folate, also known as B9, is a naturally occurring vitamin.

• Folic acid is a synthetic form of folate found in vitamins and fortified grains.

• MTHF folate or methylfolate is the form most easily absorbed and used in the body.

• Most adults are recommended to consume at least 400 mcg/day through supplements or diet. Pregnant people or those trying to get pregnant should be taking closer to 600 mcg/day. 

• Low levels of folate during pregnancy may lead to complications such as neural tube defects, anemia, premature birth, and low birth weight. 

• Two common neural tube defects are spina bifida and anencephaly. Spina bifida may result in moderate to severe disability. Anencephaly is a fatal condition. 

• The upper limit of folate for adults is 1,000 mcg/day. Alway speak with your healthcare provider for specific guidance on your nutrition and supplementation, especially when trying to conceive or pregnant. 

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