Folate and folic acid

Folate is an essential B vitamin found naturally in foods such as:

• green leafy vegetables such as spinach and broccoli
• citrus fruit such as oranges, mandarins and lemons
• wholemeal bread
• legumes such as dried beans, peas and chickpeas
• animal liver.

Safe and healthy eating in pregnancy — HealthEdexternal link

Folic acid is the synthetic, manufactured form of folate. Folic acid is used in dietary supplements and fortified foods and drinks. It is better absorbed and used in the body than natural folate.

Folate is important for cell growth and creating new cells. Folate deficiency can lead to a type of anaemia called megaloblastic anaemia. This is a blood disorder in which there are enlarged, immature and poorly functioning red blood cells.

Folic acid deficiency anaemia

Folate also helps with the healthy development of pēpi in early pregnancy. A deficiency of folate has been linked with a higher risk of neural tube defects (NTDs).

Neural tube defects are major birth defects where the brain, spinal cord or the covering of these organs have not developed properly. Spina bifida and anencephaly are the most common types of NTDs.

Spina bifida is the most common NTD. It happens when the spine does not close properly during the first month of pregnancy. Tamariki born with spina bifida can have a varying degree of paralysis of their legs. Some will need to use a wheelchair for their lifetime, whereas others have almost no symptoms. The condition can also cause bowel and bladder problems.

Pēpi born with anencephaly have underdeveloped brains and incomplete skulls. Most pēpi born with anencephaly do not survive more than a few hours.

The rates of NTD live births for different populations were:

• wāhine Māori, 4.58 for every 10,000 births
• Pacific Island women, 4.09 for every 10,000 births
• European and other women, 2.81 for every 10,000 births.

Aotearoa New Zealand has introduced a policy for folic acid supplementation to reduce the risks of NTDs.

Women at low risk of having pregnancy affected by NTD

Women at low risk who plan to become pregnant are recommended to take an 0.8 milligram (800 microgram) tablet of folic acid daily:

• for at least 4 weeks before getting pregnant
• until 12 weeks into pregnancy.

This is to reduce the risk of NTDs.

Folic acid and spina bifida — HealthEdexternal link

Women personally, or with family or partner, affected by NTD

Some women are recommended to take a higher dose of 5 milligram (5,000 microgram) of folic acid daily. This includes women:

• themselves affected with a NTD
• with a previous child with a NTD
• with a close family member who has had a NTD
• women whose partner is affected or had a family history of NTD.

To reduce the risk of NTDs, these women are recommended to take the higher dose for subsequent pregnancies:

• for at least 4 weeks before getting pregnant
• until 12 weeks into pregnancy.

Women using insulin for diabetes treatment

A daily folic acid tablet of 5 milligram (5,000 microgram) is also recommended for women who are on insulin treatment for diabetes.

This tablet should be taken for at least 4 weeks before getting pregnant until 12 weeks into pregnancy to reduce the risk of NTDs.

Women taking medicines that affect folate metabolism

A daily folic acid tablet of 5 milligram (5,000 microgram) is also recommended for women who are taking medicines known to affect folate metabolism, including antiepileptics (for example, carbamazepine, sodium valproate).

This tablet should be taken for at least 4 weeks before getting pregnant until 12 weeks into pregnancy to reduce the risk of NTDs.

In Aotearoa New Zealand, just over half of pregnancies are unplanned. This means many women do not take folic acid supplements in the critical 4 weeks before and 12 weeks after getting pregnant.

Fortification of a food is the only other way to help make sure this group of women gets enough folic acid. Fortification is used internationally and is a well-accepted and safe public health approach.

In 2021, the New Zealand Government announced mandatory folic acid fortification of non-organic wheat flour used in making bread.

Other foods, such as breakfast cereals, fruit and vegetable juices, soy milk, certain food drinks (for example, liquid meal supplements) and gluten-free breads may also contain added folic acid.

There is more information on the regulation of folic acid fortification on the Ministry for Primary Industries website.

Fortification of flour with the B vitamin folic acid — Ministry for Primary Industriesexternal link