If you’re pregnant, it’s highly likely you’ve heard about taking folic acid for pregnancy.
The difference between folic acid and folate can be very confusing for many people, but it’s critical to understand.
Folate is a naturally occurring B-vitamin.
Folic acid is produced in a lab and is a synthetic version of folate.
Many women are told to supplement with folic acid when planning to become pregnant and during the early weeks of pregnancy. Though some may not know why it’s necessary.
Adequate folate is necessary to help the baby’s neural tube (which becomes the central nervous system, including the brain and spinal cord), to develop properly, as well as prevent a major birth defect, spina bifida, from occurring — by up to 70%.
Because our bodies don’t store folate, consuming adequate amounts regularly is something we need to be aware of.
Folic Acid For Pregnancy – What You Need To Know
Before taking folic acid for pregnancy, it’s important to understand how very different synthetic folate (folic acid) is compared to natural folate.
Let’s go over the two forms in more detail.
What Is Folate?
Folate is a water soluble B-vitamin also known as B9.
Just like vitamin C, our bodies do not store folate, instead excreting any unused vitamin through the urine.
This means we need to regularly eat foods that contain folate, such as:
- Green leafy vegetables (spinach, lettuce, parsley, cauliflower, broccoli, beetroot, asparagus)
- Fruits (mangoes, grapefruit, papaya, strawberries, raspberries)
- Beans, peas and lentils
- Seeds and nuts
- Beef and chicken liver
Folate works with vitamin B12 and vitamin C to help our bodies break down, utilise and make new proteins.
It also helps red blood cells to form and produce DNA. Our DNA carries genetic information in our body.
Folate plays a very important role in the healthy development of babies during pregnancy, especially in the very early weeks when the neural tube is forming.
At around days 21-28 after conception, the neural tube formation is complete.
Folate Versus Folic Acid
Folic acid is the synthetic, manufactured form of folate.
Folic acid is used in supplements and is added to food that we eat, particularly flour products like breads and cereals.
Bread and cereal products are best avoided or used sparingly anyway, since they are high in carbohydrates and may increase your risk of gestational diabetes, thrush and other health problems.
Folate and folic acid are not equal.
Synthetic folic acid and folate from food are utilised differently in the body.
- Folate is metabolised in the stomach.
- Folic acid is metabolised in the liver.
Synthetic folic acid cannot cross the blood-brain barrier, whereas folate can.
Excess folic acid may mask or worsen a B12 deficiency.
How Folic Acid Was Added To Our Foods
In the 1980s, researchers looked at the blood work of women who had babies with neural tube defects (NTDs).
The researchers discovered the women were deficient in certain micronutrients, particularly folate.
Later research showed supplementation with folate before conception reduced the occurrence of NTDs.
Plenty of women have unplanned pregnancies, so they were not getting enough folate at the critical time of pregnancy. Therefore, NTDs continued to occur.
As a result, many countries worldwide have introduced mandatory folic acid fortification to certain foods, such as flour.
Most government health websites state that all women of childbearing age should be supplementing with folic acid, in an attempt to prevent NTDs in the case of an unplanned pregnancy.
It’s assumed most women do not eat a balanced diet, and would not be able to consume enough folate in natural form.
The current recommendation for folic acid for pregnancy is to take 400mcg daily.
Authorities recommend that women should take folic acid at least one month prior to conception, and then ongoing during the first trimester.
Too Much Of A Good Thing?
While the occurrence of NTDs has been reduced since mandatory folic acid fortification was introduced in many countries, there are concerns that high levels of folic acid are not safe.
There have been studies reporting the presence of unmetabolised folic acid in the blood after consumption of folic acid supplements or fortified foods.
Folic acid is metabolised in the liver, which becomes saturated quite rapidly, leading to excess spilling into the bloodstream.
Excess folic acid can reduce the effectiveness of natural killer cells.
Studies have suggested high levels of folic acid may increase the odds of developing cancer.
Research from Norway, where there is no folic acid food fortification, showed increased cancer outcomes were linked to folic acid.
Heart disease patients who were treated with folic acid and vitamin B12 had a higher risk of developing and dying of cancer.
Yet another study suggests women who take folic acid supplements may be at risk of developing and dying of breast cancer.
There is also the issue surrounding those women who are unable to properly absorb synthetic folic acid because they have a genetic mutation of the MTHFR gene.
MTHFR Gene Mutation and Folic Acid
The MTHFR gene mutation is very common, and is said to occur in almost 1 out of 2 people mildly and 1 in 4 seriously.
The chances you have this mutation to some degree are very high – read more about how MTHFR can affect pregnancy.
Synthetic folic acid is converted into methylfolate via a process called methylation. This process requires a certain enzyme created by the MTHFR gene.
When these genes are mutated, the result is a defective enzyme that can’t convert folic acid into methylfolate.
Doctors do not commonly test for MTHFR. So if you’re not aware you have this genetic mutation, it’s possible that any folic acid supplements you take will have little effect.
Your doctor can organise a test upon request, if you’d like to know your MTHFR status.
What Should You Do?
While there’s no doubt folate deficiency can have devastating effects on the development of babies, taking synthetic folic acid for pregnancy may be causing more harm than good.
Many flour products have added folic acid, which can mean pregnant women are consuming well above the recommended levels of folic acid.
The best way to increase your folate level is to consume a variety of foods which are rich in naturally occurring folate. Also, be aware of how much fortified food you are eating.
You can now purchase pre-natal vitamins which contain methylfolate instead of folic acid.
Optimal Prenatal is one of these formulas, which won the 2018 Women’s Choice Awards for prenatal supplements.
Also, speak to your naturopath or nutritionist to get access to practitioner only brands.
Be an informed and active participant in your care before and during your pregnancy.
While recommendations and guidelines can sometimes be helpful, your personal circumstances are unique.
Choosing a maternity care provider who understands the differences between folate and folic acid, and provides individualised care, can also help you to make informed decisions about your care.
Should You Take Folic Acid For Pregnancy?
See this video from Dr Benjamin Lynch for more detailed information.