When it comes to preconception and prenatal health, folate is king. This is not common knowledge but it should be, and here’s why.
Vitamin B9, also known as folate, is a nutrient that is involved in a number of vital functions. It is most commonly known for preventing neural tube defects but is also involved in DNA synthesis and repair, blood cell production, and rapid cell division during gestation and infancy. Less commonly known is the role folate plays in supporting healthy cognitive function and reducing miscarriage risk. Folate deficiencies are associated with a higher risk of congenital heart defects, low birth weight infants, and preterm birth.
Folate is available in food sources such as legumes, beans, seeds, eggs, organ meats such as liver, and left green vegetables but it is also commonly supplemented during preconception and throughout pregnancy via your prenatal vitamin.
What is folic acid?
Folic acid is a synthetic version of folate. It is structurally and functionally different from folate that exists in nature. In order for your body to use folic acid, it needs to be converted to folate, the biologically active form of this vitamin.
Here is where things get interesting.
The conversion of folic acid to folate requires a specific enzyme called MTHFR, but not all people are capable of this conversion. We’re learning more and more about MTHFR and the genetic mutations associated with it. But what you need to know is that if you fall in the category of people who carry this gene mutation, you are not getting folate despite taking folic acid.
Why is folic acid important?
Because we are seeing up to 60% of the population carrying a defect in the gene that codes for this enzyme. That’s half the population! Half of mamas are not getting this super important nutrient if their focus is only on folic acid! A cause for further concern is the fact that unconverted folic acid may raise homocysteine levels, an inflammatory marker that is associated with injury to the vascular structures of the placenta that form in early pregnancy. High levels of homocysteine have been associated with pregnancy loss, fetal growth restriction, and preeclampsia. Learn more in my recent video on folate versus folic acid here.
How to get more folates during pregnancy?
- You can eat a diet rich in folates— think leafy greens, legumes, liver, eggs, and seeds.
- You can supplement with active folate instead of folic acid. Active folate has superior utility so your body can use it effectively. Look on the label of your prenatal vitamin or folate supplement to make sure you are seeing “5-MTHF”, “L-methyl folate” or “L-5-methyltetrahydrofolate”
- You can get a genetic test to identify if you carry the MTHFR variation.
Why would my doctor recommend folic acid?
Most studies on preventing neural tube defects have been done using folic acid, not folate. And while we always want to be using evidence-based medicine when selecting supplements, common-sense medicine dictates that the biologically active form of the vitamin is at least as effective in improving folate biomarkers.
Folic acid is also favoured by supplement companies because it is more heat stable and costs much less which makes for efficient production. This is why you’ll find prenatal vitamins containing folic acid at a much lower price point than those containing active folate
If you are still skeptical about switching from folic acid to folate, you must know that unmetabolized folic acid is not without harm. If by chance you fall into that 60% of the population that cannot convert folic acid to folate, and folic acid is building up in your system, you are at risk for oxidative stress, inflammation, and vitamin b12 deficiency (and your fetus is too, if you are pregnant).
How much folate should I take during pregnancy?
The recommended dietary allowance (RDA) for folate is 600mcg in pregnancy (up to 1000mcg) and 400mcg for non-pregnant persons.
Folate from food does not accumulate with your supplemented dose, so go ahead and enjoy those natural food sources folate. Be cautious around the overconsumption of folic acid fortified foods for the same reasons already mentioned.
So whether you’re just starting to think about conceiving or are well into your pregnancy, be sure you are choosing a prenatal vitamin that contains the active form of folate. It’s never too late to make the switch.
You should always speak with a healthcare practitioner before beginning any new supplement routine. To book an appointment to discuss your nutritional needs before, during, or even after pregnancy, contact us today.
- Obeid, Rima, Wolfgang Holzgreve, and Klaus Pietrzik. “Is 5-methyltetrahydrofolate an alternative to folic acid for the prevention of neural tube defects?.” Journal of perinatal medicine 41.5 (2013): 469-483.
- Ferrazzi, Enrico, Giulia Tiso, and Daniela Di Martino. “Folic acid versus 5-methyl tetrahydrofolate supplementation in pregnancy.” European Journal of Obstetrics & Gynecology and Reproductive Biology (2020).
- Serapinas, Danielius, et al. “The importance of folate, vitamins B6 and B12 for the lowering of homocysteine concentrations for patients with recurrent pregnancy loss and MTHFR mutations.” Reproductive Toxicology 72 (2017): 159-163.
- Nelen, Willianne LDM, et al. “Maternal homocysteine and chorionic vascularization in recurrent early pregnancy loss.” Human Reproduction 15.4 (2000): 954-960.