Folic Acid

by

Dr. Amanda Weber
Dr. Anup Patel

Shared Decision Making Tool

What is it?  

Folic acid and folate are different terms for the same B vitamin.  Folic acid is necessary for growth and repair of every cell in the body including red blood cells, hair, skin and nails.  Folic acid is also very important for the development of a human baby, very early in pregnancy.  

Who needs it?

Everyone needs folic acid for normal body functions.  This is important in teenage girls and women who are having the menstrual cycle. Birth defects have been associated with low amounts of folic acid.  The U.S. Public Health Service, Centers for Disease Control, and the Institute of Medicine says that teenage girls should get at least 400mcg (0.4 mg) of folic acid every day.  Doctors and nurse practitioners recommend young women with epilepsy start taking folic acid in the teen years:  because we know that many anti-seizure medications may lower the body’s folic acid levels.

What do we know?

Women low in folate who become pregnant are at greater risk of giving birth to low birth weight, or premature babies.  There is also a higher risk of birth defects.

Young women can lower the risk of birth defects by up to 70% by taking folic acid.  The supplementation needs to start before a woman gets pregnant to be most effective.  An example of a defect would be a neural tube defect.  Neural tube defects happen when the tube that eventually turns into the baby’s brain and spine does not form right.  These can cause lifelong disability or death for the baby.  

Are some people at higher risk of having a baby with a neural tube defect?

Yes.  Extra folic acid is especially important for women who have had other children with neural tube defects, women with diabetes whose blood sugar is high, women who are Latino, and in women who take some medications-including some that treat epilepsy, obesity, high temperatures in early pregnancy.  These are only a few examples.

How much should be taken?

Most epileptologists (epilepsy doctors) recommend doses of 400 mcg (0.4 mg) to 1000mcg (1mg) of folic acid.  This is recommended even in women who have no plans of getting pregnant.  In women with a family history of a neural tube defect, 4000mcg (4 mg) is recommended and vitamin B12 levels are usually checked with this.

Where can I look for more information about folic acid supplementation?

Epilepsy Foundation:  http://www.epilepsy.com/information/women/all-women/folic-acid

CDC:  Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/folicacid/index.html

Options for Folic Acid Supplementation

Children’s Multivitamins often have 200mcg of Folic Acid or less, and are not recommended

Most women’s multivitamins contain at least 400 mcg Folic Acid, between $6 and $10 for a 1-2 month supply

Folic Acid 800mcg, around $4 for 100 tablets.   Folic acid 1 mg tabs are also on the $4 (30-day) and $10 (90-day) drug lists at Walmart, CVS, Walgreens, Target, and Giant Eagle.