If you are trying to conceive (TTC) or pregnant, you’ve probably heard of folate or folic acid. But do you know what folate does? Did you realize that some prenatal supplements contain folic acid, but others contain a form of folate called methyl folate? For many people, prenatals with folic acid are enough but other people may need supplements with methyl folate. If you have been struggling with infertility or pregnancy loss, or have had a child with a neural tube defect, there is even more reason to learn more about folate.
This post may contain affiliate links, which means I’ll receive a commission if you purchase through my links, at no extra cost to you. Please read full disclosure for more information.
What is folate?
Folate is a water-soluble B vitamin: vitamin B9. Folate is found in many foods, but it is so important that it is added to fortified foods and supplements like multivitamins. The role of folate in the body is somewhat complex, helping in the process of making DNA, RNA, and amino acids. There is a lot we don’t know yet about folate’s role in our bodies, and there’s a lot that scientists and physicians do know that I myself don’t fully understand. But to the best of my knowledge: folate is an important part of the process of cell growth and division, which happens rapidly in a growing embryo.
Why is folate important for TTC and pregnancy?
Folate is especially important while TTC and during pregnancy. During pregnancy, maternal folate levels decrease significantly unless supplements are taken. And most people don’t get enough folate intake even with fortified foods.
Folate is very important for pregnancy and fetal development in a lot of ways. Adequate folate intake protects against fetal neural tube defects. A neural tube defect is when the developing spinal cord doesn’t close properly, leading to spina bifida or anencephaly. There is also good evidence that a maternal deficiency in folate during pregnancy can lead to higher risk of autism in the child.
Maternal deficiency in folate during pregnancy can also lead to orofacial (mouth and face) defects in the baby and leanness. It can also lead to a higher chance of preterm birth and small size for gestational age. There is also some evidence that maternal folate deficiency in pregnancy could increase risk of cleft lip or palate defect, heart defect, or limb defects.
Folic acid vs methyl folate
We can get folate in 2 different forms. Supplements can include either folic acid or 5-methyltetrahydrofolate (5-MTHF). 5-methyltetrahydrofolate (5-MTHF) is also known as methylated folate or methyl folate.
Folic acid is common in supplements like prenatal vitamins, as well as fortified food. In order to be used by the body, folic acid must be converted in the liver. The liver converts folic acid into 5-MTHF (methyl folate). Then the folate can be used by the mom or the baby in the womb.
Methyl folate does not need to be converted in the liver, so supplementation with methyl folate can be helpful for some women.
Who should use methyl folate?
People whose liver has a reduced ability to process folic acid, either due to genetics or medications, should use methyl folate. Per the American Pregnancy Association, it is estimated that 25-60 percent of the population have a variation in MTHFR genes that negatively impacts their ability to convert folic acid to 5-MTHF (methyl folate). If these people supplement with folic acid, folic acid will build up in the blood, but the folate will not be available for the body to use. That’s because it is not being converted into methyl folate. High levels of folic acid in the blood can also have negative effects on the growing baby, leading to higher risk of autism and food allergies.
How much folate should a prenatal have?
The American Pregnancy Association recommends 600-800 micrograms of folic acid for one month before TTC and for the first 3 months of pregnancy. It is not recommended to take more than 1000 micrograms, but of course you should go by whatever your provider recommends.
For methyl folate, it is measured a bit differently. The label should read something like “600 mcg DFE”. DFE stands for dietary folate equivalents. If your provider recommends methyl folate, ask your provider what amount of methyl folate you should look for in a prenatal. The prenatals by Ritual contain 1000 mcg DFE. Thorne prenatals contain 1.7 mg DFE, which is equal to 1,700 mcg DFE. So there is a lot of variation amongst prenatal vitamins.
Shopping for Prenatals with methyl folate
If you need to start taking a prenatal with methyl folate, you will likely need to order online. I was unable to find any prenatals with methyl folate in my local drug stores or vitamin shops. There are many options online. Ritual is a well-known brand that also contains choline, Omega-3 DHA, and chelated iron that is supposed to be easy on the stomach. Thorne is another good brand, but does not contain Omega-3 DHA.
In my personal experience, my stomach did not tolerate the capsules by Ritual when I began experiencing nausea during pregnancy. I did better with a gummy vitamin by SmartyPants, which also contains methyl folate and Omega-3 DHA. The gummies do not contain iron or choline, so I did choose to take those supplements separately. But I was able to keep them down, which was the most important for me.
Other sources of folate
Many foods contain folate. Per the NIH, vegetables (especially dark green leafy vegetables), fruits and fruit juices, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry, and grains all contain folate. For more details about how much folate is in a serving of different foods, check out the chart at the NIH.
Other foods are now fortified with folic acid, as many national governments attempt to decrease neural tube defects. Common fortified foods include enriched breads, cereals, pasta and even flour and corn meal. It is important to note that these foods are fortified with folic acid, not methyl folate. If you are one of those people who are not able to properly process folic acid, these fortified foods won’t be very effective for you.
A note about Megaloblastic anemia
Megaloblastic anemia can be caused by a folate deficiency, or a deficiency in vitamin B12. Often, deficiencies in folate and vitamin B12 occur together. If you are experiencing symptoms of anemia during your pregnancy, like tiredness, weakness, and shortness of breath, let your doctor know. It may just be pregnancy symptoms, or it may be more. Your doctor can quickly and easily check for iron-deficiency anemia or megaloblastic anemia with a blood test that checks your hemoglobin levels, hematocrit, and Vitamin B levels.
If you are currently TTC, consider also reading about When to take a Home Pregnancy Test and Home Ovulation Testing
Citations
- Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyl tetrahydrofolate supplementation in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:312-319. doi: 10.1016/j.ejogrb.2020.06.012. Epub 2020 Jun 13. PMID: 32868164.
- Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4. doi: 10.1186/s40748-022-00139-9. PMID: 35818085; PMCID: PMC9275129.
- Shulpekova Y, Nechaev V, Kardasheva S, Sedova A, Kurbatova A, Bueverova E, Kopylov A, Malsagova K, Dlamini JC, Ivashkin V. The Concept of Folic Acid in Health and Disease. Molecules. 2021 Jun 18;26(12):3731. doi: 10.3390/molecules26123731. PMID: 34207319; PMCID: PMC8235569.
- Shane B, Stokstad EL. Vitamin B12-folate interrelationships. Annu Rev Nutr. 1985;5:115-41. doi: 10.1146/annurev.nu.05.070185.000555. PMID: 3927946.
- https://natalist.com/blogs/learn/mthf-folate-vs-folic-acid-whats-better-for-prenatal-vitamins
- https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#h3
- https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/folic-acid/