Folic acid is imperative for a healthy pregnancy. Studies have shown that this water-soluble B vitamin, accompanied by a healthy diet and lifestyle, also helps boost both male and female fertility.

The importance of folic acid has been further heightened by the U.S. Public Health Service and CDC recommendation that all women of reproductive age should consume 400 micrograms of folic acid daily. Dreaming of Baby speaks with Dr. Amos Grunebaum on the effects of folic acid on fertility and pregnancy.

Daniela: We have with us Dr. Amos Grunebaum, Director of Obstetrics and Chief of Labor and Delivery at New York Presbyterian/Weill Cornell Medical Center and advisor to Fairhaven Health. Welcome to Dreaming of Baby Dr. Grunebaum, we look forward to our conversation on folic acid and its effects on fertility and pregnancy. Before we start tackling this subject, it would be great if you could introduce yourself to our readers.

Dr. Amos Grunebaum: Hi, thank you for interviewing me. I am an ObGyn and have been working on the internet for over 20 years now, answering over 100,000 questions about fertility and pregnancy. Glad to answer your questions.

What is Folic Acid?

Daniela: To start with, what is folic acid?

Dr. Amos Grunebaum: Folate or folic acid is a Vitamin B that is naturally present in some foods such as leafy green vegetables. It is recommended that women trying to get pregnant and those who are pregnant eat healthy foods containing folate. However, the normal diet does not contain enough of this Vitamin B vitamin, and therefore it’s recommended to supplement the diet with at least 400-600 mcg folic acid.

Dr. Amos Grunebaum: Taking folic acid before and early in pregnancy decreases some major birth defects such as neural tube defects, and some cardiac defects and decreases the incidence of miscarriage. In order for folic acid to be effective, it must be taken at least 2-3 months prior to conception. Taking it after the pregnancy test is positive will be too late to be effective.

Daniela: In the case of an unplanned pregnancy where the mom-to-be did not take folic acid before conception, what kind of risks would this present?

Dr. Amos Grunebaum: The CDC recommends that all women who are of childbearing age should take a supplement that contains 4-600 mcg of folic acid. Even when on birth control. That is the best way to decrease the risk of birth defects. If you take it all the time, then there can be no surprises and you know that you protect yourself and the baby.

Dr. Amos Grunebaum: Unfortunately, the message that all women should take that supplement is not there yet with everybody, so we all must spread the message, especially if you are trying to conceive.

Folic Acid and Fertility

Daniela: Thank you for clarifying that. Going back to pre-conception. What is the relationship between folic acid and fertility?

Dr. Amos Grunebaum: There have been some studies showing that a healthy diet and folic diet improve your chances getting pregnant.

Dr. Amos Grunebaum: Unfortunately, a large percentage of pregnancies end in an early miscarriage, and the top reason for a miscarriage is often a fetal issue.

Dr. Amos Grunebaum: I have realized for some time that even women who actively try to get pregnant are not quite aware to take folic acid regularly, and they should know to take it all the time, especially 2-3 months before conception.

Daniela: That’s very informative; going one step before pregnancy though, how does folic acid affect fertility? Basically, how does it affect the reproductive system?

Dr. Amos Grunebaum: There is so much we don’t know yet completely about fertility. Many people including doctors don’t get enough education about how to improve the chances of getting pregnant.

Dr. Amos Grunebaum: Without enough nutrients in your diet, including folic acid, it can be difficult to get pregnant and have a healthy baby. Specifically, a folic acid deficiency can also cause anemia, which has been associated with infertility.

Dr. Amos Grunebaum, “Without enough nutrients in your diet, including folic acid, it can be difficult to get pregnant and have a healthy baby.”

Dr. Amos Grunebaum: That is why it’s crucial, for both the woman and the man. In addition to being at your optimal weight, eating the right diet and taking the right supplement will improve his sperm count and will also improve their chances getting pregnant.

Dr. Amos Grunebaum: I have seen many couples who instead of having IVF, optimized their lifestyle.

Folic Acid and Male Fertility

Daniela: You mention here male fertility; is the recommendation for folic acid supplementation the same for men as it is for women? That is, is it imperative that men also take folic acid daily?

Dr. Amos Grunebaum: What is imperative for men is to also live a healthy lifestyle. Eat the right food, be at the optimal weight. Importantly, make sure the sperms are healthy.

Dr. Amos Grunebaum: Sperm health includes having the right amount of sperms plus having sperms that have enough motility (move enough) and morphology (have the right shape)

Dr. Amos Grunebaum: For the last few years, several studies have shown that supplementing a man’s diet with antioxidants clearly improves the sperm quality. So each man should supplement their diet with a multivitamin that includes antioxidants.

Dr. Amos Grunebaum, “For the last few years, several studies have shown that supplementing a man’s diet with antioxidants clearly improves the sperm quality.”

Daniela: If I understand well then, a folic acid deficiency would affect sperm health? What kind of effects would this have on sperm?

Dr. Amos Grunebaum: Any vitamin deficiency affects sperm health so a healthy supplement including antioxidants can improve his sperm health and fertility

Dr. Amos Grunebaum: Any vitamin deficiency affects sperm health so a healthy supplement including antioxidants can improve a man’s sperm health and fertility.

How does a Folic Acid Deficiency Affect Pregnancy?

Daniela: You mentioned earlier a connection between folic acid deficiency and anemia; can you please elaborate further on this as well as how it would affect pregnancy?

Dr. Amos Grunebaum: Anemia is low red cell count and it affects fertility and can affect the pregnancy by potentially not providing enough nutrition to the fetus.

Dr. Amos Grunebaum: In addition, delivery is often associated with blood loss, so each pregnant woman must ensure she has sufficient blood reserves when having the baby.

Dr. Amos Grunebaum: Excessive blood loss is among the major reasons of mothers getting sick or even dying. So ensuring that your blood reserves are enough will ensure a woman’s health in pregnancy.

Daniela: Does this mean that folic acid should be taken all throughout pregnancy?

Dr. Amos Grunebaum: Yes, it should be taken throughout pregnancy and after pregnancy postpartum while breastfeeding too.

Daniela: That is very interesting to know – especially the postpartum aspect as it’s not really talked about. Can you elaborate a little further as to why folic acid should be continued after pregnancy?

Dr. Amos Grunebaum: Every woman loses blood during delivery, that is normal. Some lose more than others and that blood must be replenished. A woman needs many months after delivery to build up her bone marrow’s reserve, and eating well and taking the right supplement will make it easier for her to recover from pregnancy and delivery.

Dr. Amos Grunebaum, “A woman needs many months after delivery to build up her bone marrow’s reserve, and eating well and taking the right supplement will make it easier for her to recover from pregnancy and delivery.”

Nutrients Deficiency and Breastfeeding

Daniela: Would this also help in terms of breastfeeding?

Dr. Amos Grunebaum: Women who are deficient in nutrients, who are anemic for example, will be less likely to have enough milk supply as women who are not anemic

Dr. Amos Grunebaum: That’s why your postpartum recovery must include the right vitamin supplement not only to make you feel better but also to optimize breast milk supply.

Daniela: Thank you for your time today Dr. Grunebaum, you’ve helped us appreciate the importance of folic acid even more.

Dr. Amos Grunebaum: Thank you so much for today’s interview.

Read more about folic acid supplementation and Fertilaid at www.fairhavenhealth.com

Pregnant or trying to conceive? Read more about Folic Acid in this Dreaming of Baby segment:

Preventing a Folic Acid Deficiency in Pregnancy

The Effects of a Folic Acid Deficiency on a Mom-To-Be’s Health

Folic Acid and the Reduction of Pesticide-related Autism Risk

The Cost of Premature Birth

Fertility Boosting Foods

Before Getting Pregnant

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