Folate and Folic Acid for Healthy Pregnancy

Having enough folate in your blood is vital for the developing baby. Learn why this vitamin is so important and how much you need to take during pregnancy. Find out the differences between available folate and folic acid supplements and how to choose the one that is right for you.

Having enough folate in your blood is vital for the developing baby. Learn why this vitamin is so important and how much you need to take during pregnancy. Find out the differences between available folate and folic acid supplements and how to choose the one that is right for you.

Folate and Folic Acid – an Introduction

Folate and folic acid are 2 different forms of vitamin B9. This is a vitamin that plays an important role in our health. It is essential for the production and division of our cells and supports cardiovascular and brain health.

The term folate is used to describe the different types of folate found in natural sources as well as those created synthetically.

Folic acid is the synthetic version of folate that is after ingestion converted into the form, which can be used by our body (tetrahydrofolate). Folic acid is the most commonly used form of folate in prenatal vitamins.

However, more and more people are choosing another type of folate as their prenatal supplement. This type is called methylfolate and has several important advantages over folic acid supplements. We’ll discuss the reasons for this later on in the article.

Benefits of Folate and Folic Acid During Pregnancy

During pregnancy, it is vital that you have sufficient levels of folate in your blood. The reason for this is that folate is needed for the creation of new cells, tissue creation and the rapid growth of placenta and the baby.

Folate is important throughout the pregnancy, but its significance is largest in the first 12 weeks. During this early time folate supports the healthy development of the baby’s brain and spinal cord. For that reason many health organizations recommend that you start with folate/folic acid supplementation at least a month before getting pregnant.

Commonly accepted folate requirements are 400mcg while planning pregnancy and 600-800 mcg during pregnancy.

Folate and folic acid have several important functions during pregnancy. These include:

1. Preventing Neural Tube Defects

Neural tube is the part of the fetus from which later on the baby’s brain and spinal cord develop.  This tube forms in the first weeks of pregnancy and closes at around 12 weeks.

Neural tube defect happens when the neural tube doesn’t close properly. This leaves part of the spinal cord or brain exposed. Most common types of neural tube defects are spina bifida (spinal cord defect) and anencephaly (incomplete development of the brain). Neural tube defects lead to serious health issues and may even be fatal.

Large population data has shown that folic acid/folate supplementation before and during the first 12 weeks of pregnancy can prevent up to 70% of cases of neural tube defects (1).

2. Decreasing the Risk of Other Birth Defects

It has been shown that folate and folic acid also help with other birth defects. When taken before and during pregnancy, these supplements may protect the baby from developing cleft lip or cleft palate and urinary tract abnormalities.

Several studies also found s significant (24%-43%) decrease in risk for congenital heart anomalies when pregnant women took high doses of folic acid (2, 3).

Observational studies have also linked folate during pregnancy with higher birth weight and fewer preterm births (4, 5).

Folate may also help reduce the risk of pregnancy complications, such as preeclampsia and pregnancy anemia (6, 7). 

3. Folate Helps Prevent Anemia During Pregnancy

Anemia (a condition when your body doesn't have enough iron to make hemoglobin) is a common problem among pregnant women. This happens because blood volume during pregnancy increases and at the same time the developing baby uses up much of the mother's iron stores.

Folate plays an important role in the creation of red blood cells. It has been shown that having sufficient levels of blood folate reduces the risk of pregnancy anemia – especially during the second and third trimester of pregnancy.

Taking Folic Acid or Methylfolate During Pregnancy – Which One is Better?

Most of the prenatal supplements that are available today contain folic acid. The reason for this is that folic acid is cheaper to make than methylfolate. However, there are several important reasons why pregnant women should take a supplement with methylfolate and not folic acid.

Let's go through them in more detail.

The most important reason is that many people are unable to convert folic acid into the active form of folate, which is circulating in the body. This is caused by the so-called MTHFR gene mutation. There are estimates that between 40-60% of all people have some degree of this mutation (most people are unaware that they have this condition as they get sufficient folate from the foods they eat).

However, during pregnancy the body needs more folate than usually. So, even if you take a folic acid supplement, your levels of folate may be too low to support healthy development of the baby. At the same time, you may be left with unmetabolized folic acid in your blood, which potentially leads to associated health problems (such as lowered immunity).

If you, on the other hand, take methylfolate instead of folic acid, the supplement will reliably raise your blood folate levels (unlike folic acid, it is not affected by the action of the MTHFR enzyme).

Methylfolate is the form of folate that is biologically active, which means that your body can readily use it.

Other advantages of taking methylfolate over folic acid are (8, 9, 10):

  • It doesn't mask the symptoms of possible B12 deficiency, so it doesn't delay diagnosis and treatment
  • Unlike folic acid, methylfolate doesn't have upper tolerable intake limit as there are no known health risks of overdosing
  • Methylfolate and not folic acid has been shown to help alleviate the risk of pregnancy related iron anemia

A couple of studies have also linked taking folic acid during pregnancy with increased risk of asthma in infants and early childhood (11, 12), which is probably related to unconverted folic acid in the serum (so it is a side effect that doesn’t happen with methylfolate supplements).  

Recommended Prenatal Folate and Folic Acid Supplements

When you are looking for prenatal folate supplement, pay attention to what kind of folate it contains.

There are 3 main types of folate that are available in nutritional supplements:

  • Folic acid
  • Methylfolate
  • Food based folate

It is better if you stay away from supplements containing folic acid. This substance is synthetic and needs to go through a multi-step conversion process before your body can use it. As a result, folic acid supplements have many issues, which we have discussed earlier in the article.

Food based folate is a better choice; however, it is highly susceptible to oxidation and rapidly looses potency during manufacturing and storage.

Methylfolate is the recommended form. It is the bioactive form of folate (your body can use it directly) and very stable with a long shelf life.

You can get your folate as a standalone supplement or part of prenatal multivitamins.

Below, we‘ll review two high quality methylfolate supplements (the first one contains only folate and the other is a multivitamin).

Whichever prenatal supplement you choose, remember that you also need to get enough Omega 3 fatty acids.  Make sure that they are rich in DHA as this is the type of Omega 3 fat that is crucial for the development of the baby’s brain and retina (visual part of the eyes).

There are some prenatal supplements that already contain Omega 3 fatty acids. However, these supplements typically don’t contain high quality Omega 3 fats.

A good choice of DHA rich prenatal Omega 3 product is: Nordic Naturals Prenatal DHA, which contains Omega 3 fats in their preferred triglyceride form.

Life Extension Optimized Folate

Life Extension Optimized Folate is one of the most popular folate supplements. It contains the patented form of folate, called Quatrefolic. This folate has superior absorption over folic acid and the other forms of folate that has been proven in clinical studies.

Each capsule of Life Extension Optimized Folate provides 1.000mcg of folate, which covers the needs of most pregnant women (those who have high risk of neural tube defects need larger doses – up to 5.000 mcg daily). Unlike folic acid, methylfolate doesn’t have the upper tolerable intake limit, so you can safely take higher doses.

The supplement is suitable for vegans and vegetarians since it doesn’t have any ingredients derived from animal sources. It also doesn’t contain any GMO ingredients.  

Get more info and read customer reviews on Amazon: Life Extension Optimized Folate

Best Nest Prenatal Vitamins

Best Nest Prenatal contains folate in the form of methylfolate and a range of other vitamins needed for the healthy development of the baby.

One of the important pluses of this supplement is that it also contains vitamin B12 in its natural form – methylcobalamin (most supplements contain the synthetic version of this vitamin, called cyanocobalamin). Folate and B12 work together to convert homocysteine into amino acid methionine – which is an important process in the body that supports cardiovascular and brain health.

Best Nest Prenatal also contains probiotics for immune system support and enzymes for easing digestion problems that often accompany pregnancy. The supplement has a mix of 3 organic herbs: raspberry leaf for toning the uterus and ginger and chamomile for easing nausea and soothing the stomach.

(Just as a side note: some women take raspberry leaf in preparation for birth, so many mistakenly believe that it causes contractions. This is not true; you can safely take it or drink the tea made from leaves throughout the pregnancy).

Best Nest Prenatal is generally well tolerated and doesn’t irritate the stomach. It is suitable for vegetarians, but not vegans as it contains vitamin D3 derived from lanolin in sheep’s wool.

Get more info and read customer reviews on Amazon: Best Nest Prenatal Vitamins

How to Take Folate Supplements In Pregnancy

It is recommended that you start taking folate a couple of months before getting pregnant, so your body can build up its folate levels.

If your pregnancy is unplanned, start with folate supplement as soon as you find out that you are pregnant.

You need to take your supplement at least until you finish the first 12 weeks of pregnancy – during this time, folate is essential for the development of the baby's nervous system.

However, it is recommended that you continue with folate supplementation even after reaching 13 weeks of pregnancy as it has been shown that it may prevent some health complications later on in the pregnancy (for example, folate reduces the risk of preeclampsia and iron anemia during the second and third trimester).

During breastfeeding your folate requirements are increased, so keep up with supplementation as long as you are breastfeeding.

Folate Dosage in Pregnancy

Current recommendations for folate intake for pregnant women and women who are planning to get pregnant are:

While trying to conceive: 400 mcg of folate daily

During pregnancy: 600 - 800 mcg of folate daily

Some women have increased risk of having a baby with neural tube defects, so they need to take higher dosages of folate.  These dosages are determined individually by your health care provider and can be as high as 5mg of folate daily.

You might need to take extra high dose folate if:

  • You've had a previous pregnancy that was affected by a neural tube defect
  • You or your partner have neural tube defect or a family history of neural tube defect
  • You are having twins
  • You are significantly overweight or you have diabetes
  • You have a diagnosed MTHFR mutation (in this case, it is especially important that you take methylfolate and not folic acid supplement)
  • If you are taking certain prescription medication (such as anti-seizure drugs, diabetes medications, certain diuretics)

Sources and References: 
  1. Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Recommendation Statement.
  2. Prevention of Neural-Tube Defects with Periconceptional Folic Acid, Methylfolate, or Multivitamins?
  3. Birth Defects.
  4. Folic Acid and Pregnancy.
  6. Folic acid: for preconception and pregnancy.
  7. Why do I need folic acid in pregnancy?
  8. Folic Acid Recommendations.
  9. Folic Acid.
  10. Pregnancy Guide.
  1. Hannah Blencowe, Simon Cousens, Bernadette Modell, Joy Lawn. Folic acid to reduce neonatal mortality from neural tube disorders. (2010)
  2. Andrew E. Czeizel, Istvan Dudás, Attila Vereczkey, and Ferenc Bánhidy. Folate Deficiency and Folic Acid Supplementation: The Prevention of Neural-Tube Defects and Congenital Heart Defects. (2013)
  3. Czeizel AE, Vereczkey A, Szabó I. Folic acid in pregnant women associated with reduced prevalence of severe congenital heart defects in their children: a national population-based case-control study. (2015)
  4. James A Greenberg, stacey J Bell, Yong Guan, and Yan-hong Yu. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention. (2011)
  5. Lassi ZS, Salam RA, Haider BA, Bhutta ZA. Folic acid supplementation during pregnancy for maternal health and pregnancy outcomes . (2013)
  6. Wang Y et al. Folic acid supplementation and dietary folate intake, and risk of preeclampsia. (2015)
  7. Shi Wu Wen et al. Folic Acid Supplementation in Pregnancy and the Risk of Pre-Eclampsia—A Cohort Study. (2016)
  8. James A Greenberg and Stacey J Bell. Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and l-Methylfolate. (2011)
  9. James A Greenberg et al. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention. (2011)
  10. Rima Obeid, Wolfgang Holzgreve and Klaus Pietrzik. Is 5-methyltetrahydrofolate an alternative to folic acid for the prevention of neural tube defects? (2013)
  11. Veeranki SP et al. Maternal Folic Acid Supplementation During Pregnancy and Early Childhood Asthma. (2015)
  12. Yang L et al. High dose of maternal folic acid supplementation is associated to infant asthma. (2015)

Supplements commonly used for Pregnancy:

Folate and Folic Acid

Having enough folate in your blood is vital for the developing baby. Learn why this vitamin is so important and how much you need to take during pregnancy. Find out the differences between... read more…

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