How do you treat folate deficiency in pregnancy? A comprehensive guide

November 7, 2025 •

4 min read

Studies show that taking folic acid before and during early pregnancy can help prevent neural tube defects, making it critical to understand how do you treat folate deficiency in pregnancy. Folate is a vital B-vitamin for both maternal health and fetal development, and a deficiency requires prompt and effective management.

Quick Summary

Treatment for folate deficiency in pregnancy involves a combination of prescribed folic acid supplementation and increased dietary intake of folate-rich foods. The correct approach is determined by a healthcare provider based on the individual's specific needs and risk factors.

Key Points

Supplement with Folic Acid: Supplementation is crucial for correcting a diagnosed deficiency and supporting healthy development during pregnancy.
Adjust Approach for Risk Factors: Standard recommendations differ significantly from the approach required for women with a history of neural tube defects or other high-risk factors, as determined by a healthcare provider.
Increase Folate-Rich Foods: Incorporate foods like leafy greens, citrus, and legumes to support overall health and maintain folate levels.
Consider MTHFR Variants: If you have a variant of the MTHFR gene, your healthcare provider may suggest a more bioavailable form of folate, such as L-methylfolate.
Rule Out B12 Deficiency: A doctor should test for vitamin B12 deficiency before beginning folic acid supplementation, as it can mask related neurological symptoms.
Consult a Healthcare Provider: Always seek personalized medical advice to determine the correct management plan for your specific situation.

Understanding the Importance of Folate in Pregnancy

Folate, or vitamin B9, is essential for a woman's health, especially during pregnancy. It plays a critical role in producing new cells and synthesizing DNA and RNA. For an unborn child, adequate folate levels are crucial for the proper development of the neural tube, which forms the brain and spinal cord. A deficiency can lead to severe birth defects, known as neural tube defects (NTDs), such as spina bifida and anencephaly. Pregnancy significantly increases the body's demand for folate, making deficiency a notable concern.

The Difference: Folate vs. Folic Acid

While often used interchangeably, folate and folic acid are distinct forms of vitamin B9.

Folate is the naturally occurring form found in foods like leafy greens, beans, and citrus fruits. It is less stable and can be destroyed by heat during cooking.
Folic Acid is the synthetic, man-made form used in supplements and fortified foods, such as enriched cereals and breads. Folic acid is more stable and better absorbed by the body, making it a reliable way to boost folate levels.

Core Strategies to Treat Folate Deficiency

Treating folate deficiency in pregnancy is centered on two key strategies: supplementation and dietary modification. A doctor will diagnose the deficiency with a blood test and recommend a personalized plan.

1. Folic Acid Supplementation

Oral folic acid tablets are the primary method for treating a diagnosed deficiency. The approach and duration of treatment can vary based on individual circumstances and medical guidance.

Treatment Approach: For individuals with folate deficiency, a healthcare provider may recommend a specific approach.
Preventative Approach for Pregnancy: Women who could become pregnant are often advised to take a supplement, with pregnant women needing sufficient daily intake. This is to ensure adequate folate status from the beginning of pregnancy, as NTDs develop in the first few weeks.
High-Risk Pregnancies: Higher levels of support may be necessary for women at increased risk. This includes those with a previous pregnancy affected by an NTD, a family history of NTDs, diabetes, or those taking certain anti-epileptic medications. In these cases, a doctor may prescribe a specific regimen starting before conception and continuing through the first trimester.
Consideration for MTHFR Gene: Individuals with a variant in the MTHFR gene may have trouble converting standard folic acid to its active form. A healthcare provider might recommend a supplement containing L-methylfolate (or 5-MTHF) instead, which is a bioavailable form.

2. Dietary Adjustments: Increasing Natural Folate

While supplements are critical for correcting a deficiency, diet plays a vital role in prevention and maintenance. The following foods are excellent sources of folate:

Leafy Greens: Spinach, kale, and collard greens.
Legumes: Lentils, chickpeas, and black beans.
Citrus Fruits: Oranges and grapefruit.
Fortified Grains: Many breakfast cereals, bread, and pasta products are enriched with folic acid.
Other Sources: Asparagus, broccoli, eggs, and beets.

Comparing Treatment for Folate Deficiency in Pregnancy


Feature	Folic Acid Supplements	Diet Rich in Folate
Level Management	Can provide a more controlled approach, especially for individuals requiring higher amounts as directed by a healthcare professional.	Dependent on portion sizes, cooking methods, and food absorption, making precise level management challenging.
Absorption	More easily absorbed by the body than naturally occurring folate.	Can be lost during cooking, and absorption is variable.
Reliability	Consistent and reliable way to ensure adequate intake, crucial for supporting healthy development.	Important for overall nutrient intake but may not provide sufficient levels alone, especially for a deficiency.
Comprehensive Nutrition	Provides targeted intake of folic acid, but may lack other vital nutrients.	Offers a wide range of vitamins, minerals, and fiber alongside folate.
Cost	Generally affordable, and many prenatal vitamins are covered by insurance.	Varies based on grocery costs and availability of fresh produce.
Medical Necessity	Necessary for treating diagnosed deficiency and supporting high-risk pregnancies under medical supervision.	Excellent for prevention and long-term health maintenance.

Special Considerations for Managing Folate During Pregnancy

Vitamin B12 Interaction: Folic acid supplements can mask the symptoms of a vitamin B12 deficiency, a condition that can cause nerve damage. Before recommending folic acid, a doctor will likely test B12 levels to rule out this risk.
Genetic Polymorphisms: Individuals with MTHFR gene variants should discuss supplementation options with their healthcare provider. While some studies suggest L-methylfolate may be effective for this group, it's not yet definitively proven to prevent NTDs.
Medication Interactions: Certain medications, including some anti-seizure drugs, can interfere with folate absorption and metabolism. A doctor will need to adjust supplementation accordingly.

Conclusion

Managing folate deficiency during pregnancy is a critical component of prenatal care that safeguards both the mother's and baby's health. The cornerstone of treatment involves prescribed folic acid supplementation to rapidly restore levels, combined with a diet rich in natural folate sources. Because needs vary significantly based on individual risk factors and genetics, it is essential to work with a healthcare provider to determine the right approach and treatment plan. A proactive approach to folate intake through both supplements and diet is a strategy for supporting a healthy pregnancy and potentially reducing the risk of certain congenital anomalies.

For more information on the benefits and importance of folic acid during pregnancy, consult the March of Dimes website.

Frequently Asked Questions

Folate is the form of vitamin B9 found naturally in food, while folic acid is the synthetic form used in supplements and fortified foods. The body absorbs folic acid more easily than natural folate, making it a more effective source for increasing folate levels.

Healthcare providers offer guidance on appropriate folic acid intake during pregnancy. Women at higher risk of neural tube defects may receive specific recommendations from their doctor.

Common symptoms include fatigue, weakness, pale skin, shortness of breath, a sore tongue, and mouth sores. More severe cases can affect memory and concentration.

For most people, it can be challenging to meet the increased folate needs of pregnancy through diet alone. This is why supplementation is often recommended before and during pregnancy to support a sufficient intake.

Neural tube defects (NTDs) are serious birth defects affecting the baby's brain and spinal cord, such as spina bifida and anencephaly. Folate is crucial for the proper formation of the neural tube in the earliest stages of pregnancy.

Excessive intake of synthetic folic acid (not natural folate from food) can potentially mask symptoms of a vitamin B12 deficiency, which can cause severe nerve damage if left untreated. This is why intake must be managed under medical guidance, especially for individuals with specific risk factors.

If you have an MTHFR gene variant, your body may not efficiently process standard folic acid. Your healthcare provider may recommend a supplement containing L-methylfolate, which is a more bioavailable form.

The duration of treatment for a deficiency can vary, often lasting for a few months. For pregnancy, it is often recommended to take folic acid supplements daily, starting before conception and continuing through the first trimester.