“Take folic acid for pregnancy!” – That’s what we hear. But what does that really mean?
Folic acid or folate, is the most well-known of the so called ‘pregnancy vitamins’ and most women are aware they should be supplementing their intake prior and during their pregnancy. But recently, it’s becoming more common knowledge that folic acid (in high dosages) might not be the best option for everybody.
So, is it as simple as looking for a supplement that contains the highest amount of folic acid? (The short answer is no) Or should you being paying more attention to the type and amount of folate that’s in the supplement your throwing back every day? (The short answer is yes)
In this article, we explore everything you need to about folate so you are fully armed with all the knowledge and tools to wade through what can be a really noisy area in the online space (particularly, social media) on this topic.
Should I take Folic Acid For Pregnancy? (What is Folate/Folic Acid?)
Folate is vitamin B9, it is a water-soluble vitamin primarily found in green vegetables such as spinach, broccoli, asparagus, kale, as well as legumes and beans and some fruits like strawberries & oranges. Folate is what this nutrient is referred to when it occurs naturally in these foods.
Folic acid is the synthetic form of folate and it is still the same vitamin B9. However, this is the form found in many conventional prenatal supplements as well as what is added to our non-organic wheat bread flours. (This is mandated by the government because it is a safe and effective strategy to reduce neural tube defects, like spina bifida in those with unplanned pregnancies who may not be taking folic acid or a prenatal supplement.)
These two forms of the same nutrient are not metabolised the same in the body, and our unique genetic make-up may influence how we best utilise this all-important nutrient. But more on that in a moment…
What Does Folate do in the Body? And Why is it So Important in Pre-Conception and Pregnancy?
Folate is a crucial vitamin to support the creation of DNA or genetic material, and supports cell division. Obviously, pregnancy is a time where lots of new cells are being made and divided so folate is needed in an additional amount to keep up with the demands.
We also know that supplementing with folate prior to pregnancy and during the first trimester, in particular, is crucial to reduce the risk of neural tube defects, such as spina bifida in 7 out of 10 cases (BetterHealth). Your baby’s neural tube starts to form between weeks 4-6 of pregnancy, which is often when you just found out you’ve missed your period and getting a positive pregnancy test.
The neural tube is their future brain and spinal cord, so it is important to support its development during this window. So, being proactive about folate supplementation prior to conception and during pregnancy is key.
New Australian research has shown that we should not stop our prenatal supplements containing folate after the first trimester though, as many people think, well, the neural tube is formed now and all healthy, no need.
This research from 2020 has shown that less than 1% of pregnant women in their third trimester are able to meet their nutrient demands for folate, zinc, iron, calcium and dietary fibre through diet alone. (Slater et al., 2020)
It is recommended to commence a specific prenatal multi-vitamin at least 1 month, or ideally 3 months prior to conception, to ensure you are all topped up with this important nutrient and continue throughout pregnancy and into post-partum to support your breastfeeding needs and post-partum recovery.
How Much Folate is Enough? Isn’t More Better?
So if folate is so wonderful, surely the more the better, right?
The guidelines set out by the National Health and Medical Research Council – which is used for the Royal Australian New Zealand College of Obstetricians & Gynaecologists recommendations – state that 400 mcg of folic acid per day prior to conception and during pregnancy is sufficient.
This leaves a gap of 100 mcg per day prior to conception, to achieve your folate targets through diet by including green leafy vegetables, fruits and legumes and beans as well as fortified breads and cereal products too. During pregnancy, this gap increases to 200 mcg per day to achieve your folate target of 600 mcg per day total through a combination of supplementation and diet.
Some people with specific medical backgrounds, family histories and medications require significantly more folate than what is recommended by these organisations, so speak to your GP, an expert fertility & pregnancy dietitian or your obstetrician & gynaecologist about your unique requirements.
More isn’t necessarily better.
High levels of unmetabolized synthetic folic acid in the bloodstream during pregnancy have been associated with masking a vitamin B12 deficiency and may even increase the risk of your baby developing asthma according to some research (Wang et al., 2015).
The upper limit of folate is set at 1000 mcg per day or 1 mg per day (NHMRC). This may be safely exceeded under guidance of a medical professional and/or dietitian, based on your individual health history.
So, what happens if you’re not able to utilise the synthetic form of folic acid due to your individual genetic make-up?
MTHFR sounds like yet another complicated acronym to add to your ever-growing dictionary of pregnancy related terminology!
MTHFR stands for: Methylene-Tetrahydrofolate Reductase, it is an enzyme that helps in one of the steps of folate metabolism in which is helps convert some of the synthetic folic acid into its activated (also known as methylated) form, 5-methyltetrahydrofolate (5-MTHF, for short).
Naturally, as we are all individuals, each one of us can carry different genetic polymorphisms (or variations). These differences can change how efficiently the enzyme is working to convert synthetic folic acid into the methylated folate form – which ultimately is the form that helps support your body and your future baby’s growth and development, particularly in those early weeks of pregnancy.
There are 34 known MTHFR genetic variants, with only two of them being tested for (C677T and A1298C) due to the lack of research regarding the other 32 variants.
The loss of enzyme function to do its job of converting synthetic folic acid into its activated form depends on which variant you have and whether you have one or two copies of the gene. It can range between 10-70% reduction in function, so there is a lot of room there for synthetic folic acid to be utilised just fine by many, but also not so well by others.
This is theorised to lead to a back log effect of synthetic folic acid, remaining unmetabolized and non-activated folate, meaning it can’t get to work on supporting your red blood cells and cell division, which in some circumstances can lead to folate deficiency. It may also lead to an elevation of homocysteine levels, which is a by-product of the folate metabolism cycle. High levels of homocysteine are linked with higher risks of stroke and heart disease (Ganguly & Alam, 2015).
How do I know if I have MTHFR or not?
So you may be wondering, how on Earth do you know if you have one of these MTHFR genetic variations or not?
Fortunately, there is a simple blood test that you can do to work out whether you carry any copies for the C677T or A1298C gene which may impact on your ability to metabolise folate as well as perhaps those without these gene variations.
Unfortunately, this test is not available to everyone. In fact, you may need to meet certain criteria to be eligible for this test through your GP, which may include a family history of MTHFR genetic variations, history of homocysteine related stroke, history of recurrent miscarriage (3 or more) as well as a number of other medical factors that need to be accounted for.
It is estimated according the US based data that 10-15% of Caucasian Americans and 25% of Hispanic Americans carry a MTHFR gene variation, so it’s safe to say this is probably more common than we know about and is simply flying under the radar, as rarely are people experiencing symptoms of their slight genetic difference (NIH).
Is it better to assume that there is a MTHFR and prescribe prenatal that include an activated form, such as folinic acid or 5-methyltetrahydrofolate, or take a risk by continuing with folic acid without awareness of MTHFR status?
Supplementing with the Right Form of Folate
The good news is, there are alternatives available! More and more prenatal supplements are aware of the importance that this crucial nutrient needs to be metabolised by all mums-to-be not just a percentage of them!
Looking for a prenatal supplement that contains 400-500 mcg of already activated folate can be a way to ensure you are receiving folate in the form that you can metabolise.
The names for these vary, so here is a list:
- Folinic acid
- Levomefolate calcium
- 5-L-MTHF (or 5-L-methyltetrahydrofolate)
- Calcium folinate
Each capsule of Perdays Key Essentials with DHA contains 250 mcg of folinic acid – so with the recommended 2 capsules per day, you know you are getting the right amount of folate for your pregnancy.
These are all pre-activated forms of folic acid, meaning they are more biologically available to those with or without MTHFR gene variations to ensure you and your growing baby are getting enough of this too-important nutrient before and during pregnancy!
We need more research to be conducted in the use of pre-metabolised forms of folate particularly for those at an increased risk of having a neural tube defect-affected pregnancy, we are yet to see this research to date.
Always read the label and follow directions for use. Do not use if seal is broken or missing. Vitamins and minerals can only be of assistance if dietary intake is inadequate. Advise your doctor of any medicine you take during pregnancy, particularly in your first trimester. If you are concerned about the health of yourself or your baby, talk to your health practitioner.