Taking folic acid before conception and through the first 12 weeks of pregnancy substantially reduces the risk of neural tube defects such as spina bifida. The neural tube closes in the first 28 days — often before a woman knows she is pregnant — which is why starting early matters so much.
How much folic acid is recommended?
- 400 micrograms daily for most women, from before conception until 12 weeks of pregnancy
- A higher dose (commonly 5 mg) for women at increased risk — a previous pregnancy affected by a neural tube defect, diabetes, a BMI above 30, sickle cell disease, or taking certain anti-epileptic medicines
The higher dose should only be taken on medical advice.
When should I start and stop?
Ideally start at least one month before conception and continue to the end of the 12th week. If a pregnancy was unplanned, start as soon as you know — it is still worth taking.
Can I get enough from food alone?
Folate occurs naturally in dark green leafy vegetables, pulses, citrus and fortified flour. However, it is difficult to reliably reach the recommended amount from diet alone, and the folic acid in supplements is absorbed more efficiently than food folate. A supplement is recommended alongside a good diet, not instead of it.
Is folic acid safe?
Yes, at recommended doses. It is water soluble, and excess is passed in urine. Do not take multiple supplements containing folic acid at once without advice, and avoid vitamin A supplements (including high-dose fish liver oils) in pregnancy.
What else helps in early pregnancy?
- Vitamin D, commonly recommended at 10 micrograms daily
- Avoiding smoking and alcohol entirely
- Early antenatal booking so screening and blood tests happen on time
- Reviewing any regular medicines with a doctor — some need changing before or early in pregnancy
When should I see a doctor?
Speak to a doctor before conception if you have a chronic condition, take regular medication, or have had a previous pregnancy affected by a neural tube defect — you may need the higher dose and additional monitoring.
