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Folate vs. Folic Acid During Pregnancy

Most people who are pregnant or are trying to conceive are aware of the necessity of taking folic acid (vitamin B9), the imperative nutrient for preventing neural tube birth defects. What is less known is that there are various forms of the vitamin and that differentiating between them is important when choosing a prenatal dietary supplement.

Historically, the majority of prenatal vitamins have included folic acid, a synthetic form of the naturally occurring folate. In order for folic acid to be usable by the body, it must be converted into folate. It is estimated that roughly 40-60% of the population has one or more copies of a gene mutation that reduce the body’s ability to properly transform synthetic folic acid into folate. To make up for the diminished conversion for those with a known copy of an MTHFR variant, some doctors suggest higher doses of folic acid. More recently, some doctors have advocated adding methylated folate in lieu of the more commonly present folic acid to address the potential or known reduced capacity for utilizing the traditional form.

As we learn more about our own genetic makeup, with the advent of easily accessible genetic testing (such as 23 and Me), combined with the revelations of investigative bloodwork being done by physicians in situations involving recurring miscarriage, methylated folate is becoming known as a better option for B9 delivery. Patients who haven’t accessed their genetic map may also choose what is often called ‘bioactive’ folate as well. A recent study showed that taking folate in pregnancy compared to folic acid resulted in increased hemoglobin during the second trimester and post-pregnancy, indicating that supplementing with folate has the additional benefit of reducing anemia in pregnancy and postpartum. 

Folate plays a key role in helping our body with many biochemical processes including detoxification, estrogen metabolism, fat metabolism, cellular energy, and neurotransmitter production (including serotonin), among many other important processes for optimal health. If your body isn’t getting sufficient folate due to lack of intake or because the folic acid cannot be sufficiently converted to folate, then your body is missing a key player in the formation of certain amino acids and feel-good chemicals. This can increase inflammatory markers in the body such as homocysteine and affect the proper breakdown of histamine. Elevated homocysteine increases blood coagulation (clotting) and can be a cause of miscarriage due to decreased placental blood flow. 

Since many prenatal vitamins still use traditional folic acid, and the internet is full of information on the various bioactive versions of folate, look on the label for one of the following forms, all of which are easily absorbed: 

  • L-5-MTHF 
  • L-5-Methyltetrahydrofolate
  • 6(S)-L-MTHF
  • 6(S)-L-Methyltetrahydrofolate
  • L-Methylfolate Calcium
  • Metafolin
  • Levomefolic Acid

As for dosing, stick with the Recommended Daily Allowance (RDA) and don’t go over it unless recommended by a physician:

  • Folks trying to conceive: 400 mcg
  • During pregnancy months 1-3: 400 mcg
  • During pregnancy, months 4-9: 600 mcg
  • Breastfeeding: 500mcg

Taking enough of a good thing is important, but as with many things, too much isn’t without potential negatives. There are a lot of components to keep straight about supplementation, and your practitioner will work with you to determine what is right for you.

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