Planning a pregnancy? Start folic acid before the test turns positive

A small tablet taken before pregnancy can play an important role in your baby's earliest development.

When we think about pregnancy care, we naturally think of what needs to be done after the pregnancy test turns positive — doctor consultations, blood tests, scans, diet changes and supplements.

But one of the most important steps for a healthy pregnancy ideally begins before you even know that you are pregnant.

That step is taking folic acid.

What is folic acid?

Folic acid is the supplemental form of folate or vitamin B9, a vitamin required for the formation of new cells.

During the earliest weeks of pregnancy, your baby's brain and spinal cord begin developing from a structure called the neural tube.

Adequate folic acid around the time of conception and during early pregnancy helps reduce the risk of serious neural tube defects affecting the baby's brain and spine, including conditions such as spina bifida.

Why should folic acid be started before pregnancy?

This is the part many women do not realise.

The baby's neural tube develops very early in pregnancy, often before a woman knows that she is pregnant. Waiting until the first pregnancy consultation may therefore miss part of this important developmental window.

If you are planning a pregnancy, it is therefore better to start folic acid before trying to conceive.

Current guidance recommends taking folic acid from the time you begin trying for a baby, with starting around three months before conception being an ideal practical target.

So don't wait for those two lines on the pregnancy test.

Pregnancy preparation begins before pregnancy.

How much folic acid should you take?

For most women planning pregnancy, the routinely recommended amount is:

400 micrograms (400 mcg or 0.4 mg) of folic acid every day

Continue it through the early part of pregnancy — generally until at least 12 weeks of pregnancy.

Depending on your individual health and pregnancy needs, your gynaecologist may subsequently advise folic acid as part of a prenatal or iron-and-folic-acid supplement.

Does every woman planning pregnancy need it?

In general, yes.

You should not assume that you don't need folic acid because:

• your periods are regular
• you are young and healthy
• this is your first pregnancy
• you eat a healthy diet
• you expect conception to take several months
• pregnancy is only something you are beginning to consider

Pregnancy can sometimes occur sooner than expected, and the period when folic acid provides its most important protection begins very early.

This is why WHO recommends folic acid supplementation for women from the time they start trying to conceive.

Can I get enough folate from food?

A balanced diet is certainly important. Natural folate is present in foods including:

• green leafy vegetables such as spinach
• lentils and beans
• chickpeas
• peas
• oranges and other citrus fruits
• whole grains
• some fortified cereals and grain products

These are valuable parts of a healthy pre-pregnancy diet.

However, relying on food alone may not reliably provide the amount of folic acid recommended for prevention of neural tube defects. A daily folic acid supplement is therefore recommended in addition to eating a nutritious diet.

Do some women need more than 400 micrograms?

Yes.

Certain women have a higher risk of having a pregnancy affected by neural tube defects or have medical conditions in which a different dose may be required.

Your doctor may recommend a higher prescription dose of folic acid if, for example, you:

• have previously had a pregnancy affected by a neural tube defect
• or your partner have a neural tube defect, or there is a relevant family history
• have type 1 or type 2 diabetes
• have certain blood disorders such as sickle cell disease or thalassaemia
• take certain medicines, including some anti-epileptic medicines or medicines that interfere with folate metabolism

The appropriate higher dose can vary according to your clinical circumstances and medical guidance. Do not simply increase the dose yourself. Discuss it with your gynaecologist when planning pregnancy.

What if I am already pregnant and haven't been taking folic acid?

Don't panic.

If your pregnancy test has already turned positive and you have not been taking folic acid, start it as soon as possible and discuss your supplements at your pregnancy consultation.

The recommendation to start before conception is intended to provide protection during the earliest developmental period. It does not mean there is no benefit in starting once you discover that you are pregnant.

Pre-pregnancy care is more than folic acid

Folic acid is an important first step, but planning a pregnancy is also a good opportunity to review your overall health.

A preconception consultation can help assess:

• existing medical conditions such as diabetes, thyroid disease or hypertension
• medicines that may need to be changed before pregnancy
• previous pregnancy or delivery-related complications
• vaccination status
• anaemia and nutritional deficiencies
• weight, diet and exercise
• smoking, alcohol or other substance use
• relevant family or genetic history

For women with existing medical conditions or previous complicated pregnancies, discussing pregnancy before conception can be particularly valuable.

Small tablet. Big protection.

Pregnancy care does not have to begin with a positive pregnancy test.

If you are thinking about having a baby:

Start folic acid before conception — ideally around three months before you begin trying. For most women, 400 micrograms every day is recommended, continuing through the first 12 weeks of pregnancy.

And if you have an existing medical condition, take regular medication or have had a complicated previous pregnancy, speak to your gynaecologist before trying to conceive.

A healthy pregnancy often begins with the preparation you make before pregnancy begins.

Other related readings

• Positive pregnancy test: what does it actually confirm?
• Feeling well in pregnancy? Why regular check-ups still matter
• Preconceptional counselling
• Diet in pregnancy
• Delaying pregnancy - what to know?
• Pregnancy care at Cura Femina

References

1. World Health Organization — Periconceptional folic acid supplementation to prevent neural tube defects. WHO recommends 400 micrograms daily from the time a woman begins trying to conceive until 12 weeks of gestation.
2. Centers for Disease Control and Prevention — About folic acid
3. NICE — Maternal and child nutrition: nutrition and weight management in pregnancy. 2025 guidance recommends 400 micrograms daily and advises starting ideally 3 months before pregnancy.
4. NHS — Vitamins, supplements and nutrition in pregnancy