Folic Acid Deficiency and Its Effect on Your Reproductive Health

ByTarin Hussain
Updated: 6 Jun 2025, 1:00 pm

Folic acid deficiency occurs when your body lacks enough vitamin B9, which can lead to complications during pregnancy. Symptoms may include fatigue, pale skin, or irritability. To support a healthy pregnancy, you will need to boost your folate intake through supplements and folate-rich foods.

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Folic acid is the synthetic form of vitamin B9, also known as folate. It is a water-soluble vitamin essential for your body’s ability to create healthy red blood cells and support DNA synthesis. It’s especially important if you’re pregnant, as folate plays a critical role in your baby’s development and your reproductive health.
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When your body doesn’t get enough folate, it can lead to a condition called folic acid deficiency. This can cause a range of health issues. By understanding this condition, you can take steps to ensure you’re getting enough folate to keep your body healthy, particularly if you’re pregnant or planning to conceive.

What is Folic Acid Deficiency?

Folic acid deficiency occurs when your body doesn’t have enough folate to function properly. Folate is naturally found in foods like leafy greens, citrus fruits, and beans, while folic acid is the synthetic version added to fortified foods or supplements. It is an important nutrient that supports egg quality and ovulation.
A deficiency can lead to serious complications such as anaemia or even birth defects. This condition is relatively rare but can have significant impacts if it occurs.

Symptoms of Folic Acid Deficiency During Pregnancy

If you are pregnant and have a folate deficiency, you might notice a variety of symptoms that can affect your daily life. These symptoms often develop gradually and can be subtle at first, but they may become more noticeable if the deficiency isn’t treated. Some of the most common symptoms include:
  • Fatigue and weakness: You may feel tired or weak, as your body struggles to produce enough healthy red blood cells to carry oxygen.
  • Pale skin: A lack of red blood cells can make your skin look paler than usual.
  • Shortness of breath: You might feel out of breath even with minimal activity.
  • Irritability: Mood changes, like feeling more irritable, can be a sign of folate deficiency.
  • Lightheadedness: You might feel faint or dizzy during physical activity.
  • Rapid heartbeat: Your heart may beat faster to compensate for low oxygen levels.
  • Tongue swelling: The tongue may feel swollen or sore, which can make eating uncomfortable.
  • Mouth sores: Painful sores or ulcers in your mouth are another possible symptom.
  • Neurological issues: You could experience memory loss, difficulty concentrating, confusion, or problems with judgment.
  • Depression: In severe cases, low folate levels might contribute to feelings of depression.
These symptoms can overlap with other conditions, so it’s important to see a healthcare professional for a proper diagnosis if you notice them.

Causes of Folic Acid Deficiency

Folic acid deficiency can arise from several factors that prevent your body from absorbing enough folate. These causes can help you identify potential risks in your lifestyle or health. The main causes are:
  • Poor diet: Not eating enough folate-rich foods, like fresh fruits, vegetables, or fortified cereals, is the most common cause. This is especially prevalent in areas where malnutrition is common or if your diet lacks variety.
  • Overcooking food: Cooking vegetables for too long can destroy their natural folate content.
  • Digestive disorders: Conditions like Crohn’s disease, celiac disease, inflammatory bowel disease, or chronic diarrhoea can impair your body’s ability to absorb folate from food.
  • Excessive alcohol use: Drinking high amounts of alcohol can interfere with folate absorption and increase its excretion through urine, leading to a deficiency.
  • Certain medications: Some drugs, such as anti-seizure medications, methotrexate for autoimmune diseases, or medications for ulcerative colitis, can reduce folate absorption.
  • Hemolytic anaemia: This blood disorder causes red blood cells to be destroyed faster than they can be replaced, increasing folate demand.
  • Genetic mutations: A mutation in the MTHFR gene can prevent your body from converting folate into its usable methylfolate form.

Complications of Folic Acid Deficiency in Pregnancy

If left untreated, folic acid deficiency can lead to serious health problems for you and your baby. These complications can affect your overall well-being and are particularly critical during pregnancy.
  • Fertility challenges: Low folate levels can affect ovulation and egg quality, making it harder to conceive.
  • Folate deficiency anaemia: This condition occurs when your body doesn't have enough healthy red blood cells, and folate deficiency can lead to abnormally large red blood cells that do not function properly.
  • Neural tube defects: Serious birth defects like spina bifida (incomplete spinal cord development) or anencephaly (incomplete brain and skull development) can occur. These defects often lead to paralysis, disabilities, or stillbirth.
  • Placental abruption: The placenta may separate from the uterus, which can be life-threatening for you and your baby.
  • Preterm birth or low birth weight: Your baby may be born early or smaller than expected.
  • Autism risk: Low folate during pregnancy may increase the chances of autism in children.

Diagnosis of Folic Acid Deficiency

Your doctor may routinely check your folate levels if you're pregnant. To diagnose the deficiency, they will likely order the following tests:
  • Complete blood count (CBC): This blood test checks the number, size, and other characteristics of your red blood cells to detect anaemia and identify abnormally large cells (megaloblastic anaemia).
  • Serum folate level: This measures the amount of folate in your blood. A low level below 3 mcg/L confirms a deficiency.
In some cases, at-home testing kits are available. But it’s best to have these tests done under medical supervision, especially during pregnancy when routine prenatal checkups often include folate level monitoring.

Treatment Options for Folic Acid Deficiency

Folic acid deficiency can be effectively treated by replenishing folate levels. Your healthcare professional will plan the treatment based on the severity of your deficiency and its underlying cause. Some of its treatment options include:
  • Folic acid supplements: If you’re trying to conceive or are pregnant, your doctor may recommend 400 mcg of folic acid daily. Higher doses may be needed if you’re deficient. Supplements can be taken orally or, in severe cases, through injections.
  • Dietary changes: You’ll be encouraged to eat more folate-rich foods. A dietitian may provide a personalised diet plan to ensure you’re getting enough folate.
  • Addressing underlying causes: If a condition like celiac disease or excessive alcohol use is causing the deficiency, your doctor will work to manage these issues.
  • For MTHFR mutation: If you have an MTHFR gene mutation, you’ll need methylated folate (5-MTHF) supplements, as your body can’t process regular folic acid effectively.
  • Regular monitoring: Regular follow-ups and blood tests will track your folate levels to make sure the treatment is working and prevent any pregnancy complications.

The effects of folate deficiency should start to reverse with consistent treatment and improve your symptoms over time.

Cerebral Folate Deficiency During Pregnancy

Cerebral folate deficiency is a rare condition where there’s a shortage of folate specifically in the brain of a developing foetus. Unlike general folate deficiency, it’s caused by a genetic mutation and typically appears around age 2. Children gradually start to lose mental and motor abilities. Symptoms include intellectual disabilities, speech difficulties, seizures, and coordination problems (ataxia).
This condition requires specialised medical care and is different from dietary or absorption-related folate deficiencies.

Folic Acid Deficiency Vs. Vitamin B12 Deficiency

Both folic acid (vitamin B9) and vitamin B12 are needed for red blood cell production and DNA synthesis, but their deficiencies have some differences. Folate is found in many plant-based foods, while B12 is mainly present in animal products like meat, eggs, and dairy. This means pregnant vegetarians and vegans are at higher risk for B12 deficiency.
B12 deficiency can cause additional complications like depression, paranoia, delusions, incontinence, and loss of taste or smell, which aren’t typically linked to folate deficiency. Both can lead to fatigue, weakness, and anaemia, so proper diagnosis is important for getting the right treatment.
Folic acid deficiency is a manageable condition, but it’s important to catch it early to avoid complications during pregnancy. You can keep your folate levels in check by eating a diet rich in folate-containing foods, taking supplements when necessary, and addressing underlying health conditions. If you’re pregnant or planning to conceive, prioritising folate is critical to support your baby’s development and prevent serious birth defects.

FAQs on Folic Acid Deficiency and Its Effect on Your Reproductive Health

  1. What are the common symptoms of folic acid deficiency?
    Symptoms include fatigue, pale skin, shortness of breath, irritability, lightheadedness, and rapid heartbeat.
  2. How is folic acid deficiency diagnosed?
    It is diagnosed through blood tests such as a complete blood count (CBC) and serum folate level. A folate level below 3 mcg/L confirms deficiency.
  3. What complications can arise due to folic acid deficiency?
    An untreated deficiency may cause anaemia, low white blood cells and platelets, nerve damage or cardiovascular disease.
Disclaimer: Medically approved by Dr Poonam Agarwal, Principal Consultant, Obstetrics and Gynaecology, Sri Balaji Action Medical Institute, Delhi