What is folic acid?
Folic acid is the synthetic form of vitamin B9. This vitamin helps with cell formation, tissue growth, and blood production. At the start of pregnancy, it plays a particularly important role in the development of the baby's neural tube, the structure that gives rise to the brain and spinal cord.
Because the neural tube forms very early, often before a woman knows she is pregnant, folic acid supplementation should begin before conception. That is why this topic is part of preconception care and pregnancy planning.
Why is it so important before pregnancy?
In the first weeks of pregnancy, the embryo develops key structures very quickly. Folic acid helps reduce the risk of neural tube defects such as spina bifida and anencephaly. These problems can have serious consequences for the baby's health and for the family.
Vitamin B9 also supports cell division and the formation of the placenta and maternal tissues. While it does not guarantee a complication-free pregnancy, it is one of the simplest and most effective steps to support a safer start to pregnancy.
When should you start taking folic acid?
The most common recommendation is to start at least 1 month before trying to conceive. In many cases, health professionals advise starting 2 to 3 months before conception attempts, especially if there is a higher individual risk.
The ideal is not to wait for a positive pregnancy test. Since neural tube formation happens very early, in the first few weeks, starting only after you know you are pregnant may be too late for the preventive effect you want.
If the pregnancy was not planned, it makes sense to start the supplement as soon as pregnancy is confirmed and speak quickly with a doctor or nurse to adjust the advice.
What is the usual dose?
In Portugal, the dose most often recommended for most women planning a pregnancy is 400 micrograms per day. However, the dose can vary depending on medical history, medication, and risk factors.
Some situations require higher doses, but that should always be decided by a health professional. It is not advisable to increase the dose on your own, because more is not always better.
Who may need extra attention?
There are situations where folic acid is even more important or where the dose may need to be adjusted. Common examples include:
- a previous pregnancy affected by a neural tube defect;
- diabetes before pregnancy;
- epilepsy or use of certain anti-epileptic medicines;
- obesity;
- conditions that affect intestinal absorption;
- previous bariatric surgery;
- a very restrictive diet or known nutritional deficiencies;
- heavy alcohol consumption;
- multiple pregnancy.
In these cases, preconception follow-up is especially useful to determine the right dose and make sure the supplement is part of a broader pregnancy preparation plan.
Are folic acid and folate the same thing?
Not exactly. Folate is the natural form found in foods such as leafy green vegetables, legumes, citrus fruits, and some grains. Folic acid is the form used in supplements and in some fortified foods.
Eating a diet rich in folate is important, but it is often not enough to ensure the recommended levels before and at the start of pregnancy. That is why supplementation is recommended even when the diet is balanced.
Which foods help increase folate?
Some foods can complement your vitamin B9 intake:
- spinach, kale, broccoli, and other leafy greens;
- beans, chickpeas, lentils, and peas;
- avocado;
- oranges, tangerines, and other citrus fruits;
- nuts and seeds;
- fortified cereals, when available.
Even so, folic acid supplements remain the safest way to make sure you get the amount needed during the pre-pregnancy period.
What happens if you don't get enough folic acid?
A lack of folate can increase the risk of neural tube defects, but it can also contribute to megaloblastic anaemia, tiredness, weakness, and other signs of vitamin deficiency. During pregnancy, insufficient intake can affect embryonic development from the very beginning.
It is important to understand that the goal is not to create alarm, but to prevent problems. Taking folic acid is a simple, low-cost step with proven benefit for many families.
How to fit the supplement into your routine
Since the supplement should be taken daily, it helps to attach it to an existing routine. Some practical ideas:
- take it at the same time every day;
- link it to a meal, such as breakfast;
- set a reminder on your phone;
- keep the bottle near your toothbrush or another fixed habit;
- mark the calendar when you start the supplement.
If you have nausea or discomfort, it is worth speaking with a health professional to check the best way to take it and to see whether there is another cause.
Can I take folic acid if I have been trying to conceive for a long time?
Yes. In fact, for couples who have been trying to conceive for several months, it is even more useful to make sure the supplement is being taken correctly. Folic acid does not increase fertility by itself, but it prepares the body for a possible pregnancy and reduces risks at the start of gestation.
If conception is taking longer than expected, it may be important to have a broader fertility and general health assessment for both partners. The supplement remains part of basic care, but it does not replace an evaluation when there are difficulties conceiving.
Are there side effects?
In general, folic acid is well tolerated. Most women do not have meaningful side effects when they take the recommended dose. In rare cases, mild nausea, abdominal discomfort, or other non-specific symptoms may occur, but it is not always possible to link them to the supplement.
If you notice unusual reactions, it is important not to stop automatically without advice. The best step is to speak with a doctor, pharmacist, or nurse to understand whether you should change the brand, the timing, or the type of supplement.
What if I am already taking a multivitamin?
Many preconception or pregnancy supplements already include folic acid. In that case, the important thing is to check the total amount you are taking per day to avoid unnecessary duplication.
It is also worth checking whether the product contains other nutrients in appropriate amounts, such as iodine, iron, or vitamin D, when recommended. Not all supplements are the same, so it is a good idea to confirm the label with a health professional.
The role of the preconception appointment
Before becoming pregnant, an appointment in family planning, general practice, obstetrics and gynaecology, or maternal health nursing can help review habits, medication, vaccines, chronic conditions, and supplements. This is the ideal time to ask when to start folic acid, what dose to use, and whether there are other things to consider.
It is also a chance to talk about diet, weight, smoking, alcohol, physical activity, mental health, and emotional preparation for pregnancy. Folic acid is an important part of that package, but not the only one.
What should I do if I forget a dose?
If you miss a dose, you can usually just take it the next day, without doubling the dose on your own. The most important thing is consistency over time, not absolute perfection.
If you forget often, the problem may be the routine rather than motivation. In that case, simplifying the habit usually helps more than trying to stick to an unrealistic way of taking the supplement.
Final message
Taking folic acid before pregnancy is a simple measure, but one that has a big impact on your baby's health. Ideally, it should start at least one month before trying to conceive, although the advice may vary depending on individual risk. The usual dose is 400 micrograms per day, but some women need more specific follow-up.
If you are thinking about getting pregnant, it is best to speak with a health professional in advance. That way, you can prepare your body in time, clear up any doubts, and enter this stage with more safety and peace of mind.
