Navigating the Folate – Folic Acid Debate: What Every Future Mother Needs to Know

When it comes to preparing for pregnancy, the importance of sufficient folic acid intake cannot be overstated. This essential B-vitamin plays a crucial role in reducing the risk of neural tube defects (NTDs) – serious birth defects affecting the spinal cord and brain. The neural tube forms very early in pregnancy, at a time when most expectant mothers are still unaware of their baby. In order for the neural tube to develop normally and healthily, it needs a sufficient supply of folic acid from the mother. With approximately 3,000 pregnancies in the US impacted by NTDs each year, ensuring proper folic acid levels is paramount for maternal and fetal health.

Supplementation during preconception

Health authorities worldwide recommend supplementing with at least 400 µg of folic acid one month prior to conception and during the first trimester of pregnancy. This regimen has been shown to decrease the risk of NTDs by up to 70%, and emerging research suggests potential benefits in reducing the risk of other birth defects as well.

Folic acid versus folate

However, amidst the guidance on folic acid, confusion often arises regarding the choice between folic acid and its natural counterpart, folate. So, what exactly sets these two apart?

Folate serves as the umbrella term for both naturally occurring food folate and synthetic folic acid found in supplements. While the bioavailability of food folate is lower compared to synthetic folic acid, the latter boasts greater stability and is the preferred form for supplementation.

„Active folate“

Importantly, both forms require conversion to the active form, 5-methyltetrahydrofolate (5-MTHF), before they can be utilized by the body. While most dietary folate undergoes this conversion in the digestive system, a significant portion of folic acid must be converted in the liver or other tissues, a process facilitated by the enzyme MTHFR. However, genetic variations in MTHFR may hinder this conversion, affecting the effectiveness of folate/folic acid supplementation.

For individuals with impaired conversion, options include supplementing with 400 µg of the active form of folate or doubling the recommended folic acid dosage to 800 µg daily to achieve the desired protective folate levels in the blood.

„Generally, vitamins contain 400 to 800 mcg of folic acid, but some contain other forms of folate (such as 5-MTHF) instead. Folic acid is the only form of folate shown to help prevent NTDs. No scientific studies exist that show that supplements containing other forms of folate can prevent NTDs. It’s important to remind patients to check supplement labels to ensure they contain folic acid.“  US Centers for disease control and prevention

Benefits of 800 µg folic acid

According to Professor Christian Thaler of the University of Munich, this higher folic acid dosage benefits fertility and improves outcomes in IVF patients with the genetic variant. It also expedites the attainment of protective folate blood levels. Moreover, research by Jorge Chavarro of the Harvard School of Public Health suggests that daily folic acid intake exceeding 730 µg may reduce the risk of spontaneous abortion and stillbirth.

Armed with this knowledge, women planning for pregnancy can confidently supplement with 800 µg of folic acid daily from at least one month before conception through the first trimester, ensuring comprehensive support for maternal and fetal health.

References

US Centers for disease control and prevention https://www.cdc.gov/folic-acid/hcp/clinical-overview/

Chavarro JE, Rich-Edwards JW, Gaskins AJ, Farland LV, Terry KL, ScD, Zhang C, Missmer SA. Contributions of the Nurses’ Health Studies to Reproductive Health Research. AJPH 2016, Vol 106, No. 9.

Pietrzik K. et al. Randomized, placebo-controlled, double-blind study evaluating the effectiveness of a folic acid containing multivitamin supplement in increasing erythrocyte folate levels in young women of child-bearing age. Ann of Nutr & Metab 2005; 6.7.29: 368.

Thaler CJ. Folate Metabolism and Human Reproduction. Geburtshilfe Frauenheilkd. 2014 Sep;74(9):845-851.