TL;DR Folic acid is a type of folate- one of the B vitamins (B9). A total of 600 mcg of folic acid is recommended daily for anyone who is pregnant or could become pregnant. This can be difficult to get from food sources alone, SO a prenatal vitamin or standalone supplement containing at least 400 mcg of folic acid is recommended to help achieve this in early pregnancy *or* if you are capable of becoming pregnant and not actively trying to avoid pregnancy.
Folate vs Folic Acid? What’s the difference?
Folate has many forms. Folic acid is a form of folate that is produced for use in vitamins and supplements. It is heat stable (does not break down during cooking) and is better absorbed by the body than food sources of folate. Food sources include green leafy vegetables, legumes, and liver, but they are susceptible to breaking down during cooking.
❗Folic acid is the only form of folate that has been studied in randomized control trials to decrease the risk of a type of birth defect called neural tube defect (NTD).
Two of the most common neural tube defects (NTDs) are spina bifida and anencephaly, which are abnormalities with the spinal cord and brain. Folic acid has been shown to decrease the risk of neural tube defects (NTDs) by 70% when taken during early pregnancy.
When should I start taking folic acid?
Folic acid is important when many individuals may not yet know they are pregnant, but the neural tube needs folic acid early in pregnancy, typically four (4) weeks after conception, which is why experts recommend taking it even *before* becoming pregnant.
This is particularly important since nearly half (50%) of pregnancies are unplanned.
💥In general, if you are not *actively* preventing pregnancy, supplementing with at least 400 mcg of folic acid daily is a good idea.💥
Are other types of folate interchangeable with folic acid?
Most simply, no. Folic acid is one type of folate, and you may see other types of synthetic folate (methyl-folate, dihydrofolate, etc) marketed and sold as supplements. Many are aggressively marketed as “natural,” implying this is somehow better than folic acid. However, unlike folic acid, these other types of folate have never been shown to decrease neural tube defects (NTDs).
Additionally, while there are foods that are high in naturally occurring folate, this form of folate is prone to destruction by heating and even exposure to light. Folate content can vary significantly even within the same foods. Supplementing with a minimum of 400 mcg of folic acid daily will give your body what it needs to decrease the risk of neural tube defects (NTD).
Are there people who need more than 400 mcg of folic acid before/during pregnancy?
Yes- certain risk factors may mean you need more than the minimum recommended daily amount. These risks include (but are not limited to):
- History of a previous pregnancy affected by neural tube defect (NTD)
- Decreased ability to absorb nutrients (e.g., people with diabetes or a history of bariatric surgery),
- Taking certain medications (particularly seizure medications)
- High alcohol intake
Talk to your clinician if you have one of these risk factors and are thinking of getting pregnant.
MTHFR and folic acid?
🤓NERD ALERT🤓
There is a gene called MTHFR that plays a role in the way the body uses folate. Up to half of the population (depending on ethnic background) has one (or two) copies of a common variant (version) of this gene that is slightly less active, called 677C>T MTHFR. People with one (or two) copies of this variant have a reduced ability to convert folate to one of its active forms, 5-MTHF (5-methyltetrahydrofolate), which can result in slightly lower levels of this form of folate (5-MTHF) in the blood and slightly higher levels of homocysteine (an amino acid). Some studies have looked at whether people with this variant of MTHFR might benefit from supplementation with different versions of folate (methylfolate or methyl-tetrahydrofolate). The results of these studies are inconsistent and not compelling enough to change the folate supplementation guidelines for this population. Furthermore, only folic acid (not other forms of folate) has been proven to protect from neural tube defects (NTDs) through randomized trials – the gold standard of scientific evidence.
🎉Supplementing your diet with 400 mcg of folic acid is your best bet for protecting your unborn child from neural tube defects, regardless of your genetics. We have excellent evidence that this strategy is both safe and effective. We do not yet have good evidence about whether there may be a role for methylfolate in some individuals.
Stay safe, stay healthy, stay nerdy.
Love,
Those Nerdy Girls
Further links
Folic acid and neural tube defects
USPSTF Recommendations for folic acid supplementation
ACOG recommendations for folic acid in pregnancy
CDC FAQ and safety data, including for those with MTHFR gene variant
Folate Fact Sheet for Health Professionals (NIH)
