From the Guidelines
Folic acid is essential during pregnancy, but iron supplements are also crucial to prevent anemia and support the baby's iron stores, with a recommended dose of 27-30 mg daily, especially during the second and third trimesters. Both folic acid and iron supplements play critical roles in preventing complications during pregnancy. Folic acid, at a dose of 400-800 mcg daily, should be taken before conception and throughout pregnancy to prevent neural tube defects in the developing baby, as recommended by the American College of Medical Genetics 1. Iron supplements are also vital, especially during the second and third trimesters, to prevent anemia as blood volume increases and to support the baby's iron stores. The U.S. Preventive Services Task Force recommends screening for iron deficiency anemia and iron supplementation in pregnant women to improve maternal health and birth outcomes, with a usual dose of 60 to 120 mg of elemental iron per day 1. Many prenatal vitamins contain both nutrients, making supplementation convenient. Iron deficiency during pregnancy can lead to maternal anemia, fatigue, and increased risk of preterm birth, while inadequate folic acid increases the risk of birth defects. Some women may need higher doses of either supplement based on their health status, so it's essential to follow a healthcare provider's specific recommendations. Taking iron supplements with vitamin C can improve absorption, while calcium-rich foods or supplements should be taken separately from iron as they can interfere with absorption. Key points to consider include:
- Folic acid dosage: 400-800 mcg daily
- Iron supplement dosage: 27-30 mg daily, especially during the second and third trimesters
- Importance of prenatal vitamins containing both folic acid and iron
- Potential for increased risk of preterm birth and maternal anemia with iron deficiency
- Need for individualized supplementation recommendations based on health status.
From the FDA Drug Label
Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage Studies in pregnant women have not shown that folic acid increases the risk of fetal abnormalities if administered during pregnancy. The answer to whether folic acid is good enough during pregnancy is yes, folic acid is indicated in the treatment of megaloblastic anemias of pregnancy and its requirements are increased during pregnancy.
- Folic acid is usually sufficient for preventing fetal damage caused by its deficiency.
- There is no direct information in the provided drug labels about the necessity of iron supplements during pregnancy. 2
From the Research
Iron Supplementation During Pregnancy
- Iron supplementation during pregnancy may reduce maternal anaemia and iron deficiency at term, as suggested by studies 3, 4, 5.
- Daily oral iron supplementation can increase haemoglobin levels in maternal blood both antenatally and postnatally 3.
- Women who receive daily antenatal iron supplementation are less likely to have iron deficiency and iron-deficiency anaemia at term 3.
Folic Acid Supplementation During Pregnancy
- Folic acid supplementation is often recommended in combination with iron to prevent anaemia and improve maternal and infant outcomes 4, 6.
- Daily oral supplementation with iron + folic acid probably reduces maternal anaemia at term and may reduce maternal iron deficiency at term 4.
- However, the evidence is uncertain for the effects of iron + folic acid on maternal iron-deficiency anaemia, maternal deaths, and severe anaemia in the second or third trimester 4.
Comparison of Iron and Folic Acid Supplementation
- Iron supplementation compared to placebo or no iron may reduce maternal anaemia and iron deficiency at term, but the evidence is uncertain for other maternal and infant outcomes 4, 5.
- Iron + folic acid supplementation compared to placebo or no iron + folic acid may reduce maternal anaemia at term and improve infant birthweight, but the evidence is uncertain for other outcomes 4.
Patient Compliance with Supplementation
- Despite recommendations, the deficiency rate for iron, folic acid, and vitamin D remains high, and patient compliance with supplementation is often poor 7.
- Factors influencing poor compliance include multiparity and social assistance affiliation, highlighting the need for public health measures to improve supplementation adherence 7.