Folic Acid vs Folate During Pregnancy

By Madhavi Gupta, MD

Folic Acid vs Folate

Folate is an essential nutrient, especially during pregnancy. The benefits of folate, or vitamin B9, are well established. Yet even care practitioners can be unaware of how differently the distinctive forms of folate act in the body. It’s easy to be confused by the various terms or to assume they are interchangeable. Once you know the differences, you’ll understand how critical it is to seek out the right form.

 

What is folate?

Folate is a water-soluble B vitamin naturally present in whole foods such as leafy greens, citrus fruits, beans and other legumes, avocados, eggs, and beef liver. Folate is the generic term for food folates as well as folates in supplements and fortified foods like enriched breads and breakfast cereals. Naturally occurring food folates are in the tetrahydrofolate (THF) form. 

Folic acid is the fully oxidized monoglutamate form of the vitamin that is added in fortified foods and most dietary supplements (1). The molecular structure of folic acid is nearly identical to folate, leading to the frequent confusion that they are the same. However, that small difference can make a big difference when it comes to how folate is processed by your body.

 

Why is folate important?

Folate is a key player in methylation, playing a role in making DNA, gene expression, detoxification of cells in the brain, and regulating homocysteine, a critical factor in heart and neurocognitive health. Because folate is so important for healthy neural tube development, it’s an essential vitamin to look for in a prenatal multivitamin. But folate is important for everyone. It goes beyond early development and can influence mood, sleep, memory, and more for both children and parents.

Folate has many benefits, including:

  • Supports healthy neurodevelopment 


  • Promotes energy production


  • Improves memory & brain processing speed


  • Supports the creation of DNA


  • Helps make neurotransmitters 


     

    The Different Forms of Folate

    When it comes to understanding folate, an essential point to remember is that folate is the general term for vitamin B9. Folic acid, methylfolate, folinic acid, and food folate are all forms of folate. One common question we hear is, “What’s the difference between folic acid and folate?” Or, “Is folic acid the same as folate?” While all these forms are subtypes of folate, these subtypes are not the same. 

    Folic acid is the form commonly found in multivitamins because it is inexpensive and stable. However, those with the MTHFR gene variant (up to 60% of people) aren’t able to metabolize folic acid efficiently.

    Methylfolate is the active form found in our bodies. When you take methylfolate, your body can use it immediately because it doesn’t have to convert it to anything else. Quatrefolic® (glucosamine salt of (6S)-5-methyltetrahydrofolate) is one brand of methylfolate that is made in Italy. One advantage of Quatrefolic is that it passes through the stomach and is absorbed mainly in the small intestine. This enables Quatrefolic to ensure a higher folate uptake. Quatrefolic completely bypasses the MTHFR conversion step and delivers a finished folate the body can immediately use without any kind of metabolization.

    Folinic acid (5-formyltetrahydrofolate) is a naturally occurring folate. It can convert easily to methylfolate without the enzyme dihydrofolate reductase. This allows your body to regulate the amount of methylfolate it needs.

    It is important to note that folinic acid is different from folic acid. Folic acid is synthetic and does not exist in nature, whereas folinic acid exists naturally and is biologically active. Two words that look so alike, yet with a significant difference.

     

    Why should I take methylfolate over folic acid?

    The synthetic form, folic acid, is processed differently in our bodies. A majority of people (up to 60%) have a variation in their MTHFR gene that doesn’t allow them to properly convert folic acid into active methylfolate.

    MTHFR (Methylenetetrahydrofolate reductase) is the key enzyme that regulates this conversion process. This means that those taking folic acid may not be absorbing it as intended. If you are trying to get pregnant, consider getting a genetic test to determine if you have the MTHFR genetic variation. Furthermore, taking folic acid can block the absorption of methylfolate for many people with the MTHFR variant (2). 

    Even for people without the MTHFR variant, it’s preferable to get folate from whole food sources and supplements that contain the natural active form of folate, methylfolate, instead of synthesized folic acid.  Folic acid has to go through several steps in the body to become the active form, methylfolate, whereas a supplement with methylfolate is ready to go in the active form.

     Absorption and Transformation Steps between Folic Acid and Methylfolate chart.

    What happens to folic acid that isn’t absorbed?

    For those with the inability to process folic acid, that excess can be a problem. If your intake of folic acid exceeds your capacity to process it, it can overwhelm the liver and potentially end up in the bloodstream. There are increasing concerns that exposure to unmetabolized folic acid, which results from folic acid intakes that overwhelm the liver's metabolic capacity, may be associated with adverse effects (2).

     

    Other benefits of folate: Immunity

    Your body takes the food you eat and converts it into methyl groups. This takes time and energy and, sometimes, your body can’t do this properly. You can shortcut this process when you take methylated vitamins. With them, your body isn’t required to work extra hard to change the vitamins or food you eat into a version with methyl groups. That’s because methylated vitamins come with methyl groups that are ready to go.

    Having extra methyl groups at your immune system’s disposal can help it work efficiently without wearing you down.

     

    Why is folate important during pregnancy?

    Folate is especially important for pregnancy. During pregnancy, folate supports a baby’s healthy neural tube development and is very important in the early weeks. Recommended folate intake increases during pregnancy and breastfeeding to fuel rapid growth and help prevent neural tube defects in the fetus.

    Demands for folate increase during pregnancy because of folate’s role in nucleic acid synthesis (6), the synthesis of DNA and RNA, which is essential for the growth and proliferation of all body cells. The American College of Obstetricians and Gynecologists recommends a prenatal vitamin supplement for most pregnant women.

    An optimal folate status must be achieved before conception and in the first trimester when the neural tube closes. Many neural tube defects (NTDs) can be prevented by increasing maternal folate intake in the pre-conceptional period. Women of childbearing age should ensure a daily intake of at least 400 mcg of folate for at least 4 weeks before and 12 weeks after conception to reduce the risk of having a child with NTD (3).

    Although the generally recommended amount of folic acid for all adults is 400 mcg a day, many doctors recommend higher amounts for women who are able to get pregnant (400-800 mcg). The Mama Bird® Prenatal Multi+ line has 800 mcg of folate (as methylfolate and folinic acid) to help women meet their nutritional needs. There are also options if you are looking for a prenatal vitamin without iron and iodine or a twice-daily prenatal with extra choline.

    Can I get folate from my diet?

    Absolutely, however food folate still has to go through processes to become methylfolate, the form your body uses. There are many good dietary sources of natural folate. One easy tip is to remember the 3 L’s: legumes, leafy greens, and liver. Some fresh fruits, like citrus, are also a good option. Other food sources include nuts, seafood, eggs, dairy products, meat, poultry, and grains. For foods with some of the highest folate levels, choose spinach, liver, asparagus, and Brussels sprouts.

    However, the reality is we lead busy lives and often don’t have time to prepare and enjoy diverse, whole-food meals, or to get a recommended 6-8 servings of green vegetables a day. Plus, the depletion of soil can make many of our fruits and vegetables less nutrient-dense than they once were and that nutrients are often lost during food preparation and cooking.  Supplementation is often a great way to make sure you’re getting enough folate.

     

    What happens when you are low?

    All women capable of becoming pregnant should obtain adequate amounts of folate to reduce the risk of NTDs and other birth defects. People with the MTHFR genetic polymorphism have an impaired ability to convert folate to its active form. About 25% of Hispanics, 10% of Caucasians and Asians, and 1% of African Americans are homozygous for the 677C>T MTHFR polymorphism (4). This polymorphism results in less biologically available 5-MTHF (5-MTHF is methylfolate) and, thus, reduced methylation potential, leading to elevated homocysteine levels and an increased risk of NTDs (5,6,7,8).

    Although the research on the benefits of folate supplementation for people with this genetic polymorphism is inconclusive, these people might benefit from supplementation with 5-methyl-THF (another abbreviation for methylfolate) (7,9).

     

    Methylated Vitamins

    Best Nest Wellness supplements are made with methylated vitamins like methylfolate, the active form of vitamins found naturally in your body that come with attached methyl groups. If you are a woman of childbearing age, it’s a good idea to consider when to start taking prenatal vitamins.

    You can find methylated prenatal vitamins in our entire multivitamin line including the Mama Bird Prenatal Multi+, Mama Bird AM/PM, and Mama Bird Prenatal Multi+ Iodine and Iron Free.

    For women just beginning the pregnancy journey, there is Ready, Set, Go Women’s Fertility Formula. Or if you need even more methyl support, there is Smart Folate® Methylfolate.

     


    Older Post Newer Post

    Not sure which vitamins are best for your lifestage? Get personalized recommendations now.

    Take the Quiz