Folate and folic acid in pregnancy (2023)

Folate and its cousin folic acid are vital for the development of a healthy baby as they prevent neural tube defects. Because the neural tube develops within the first 28 days of pregnancy, all women of childbearing age are recommended to consume folate. Folate prevents certain heart abnormalities, cleft palate and cleft lip. It also lowers the risk of anemia, miscarriage, premature birth and low birth weight. It's found in fortified breakfast cereals, lentils, spaghetti, rice, beans, broccoli, orange juice, spinach, and strawberries.

What is the role of folate and folic acid in pregnancy?

Folate (vitamin B-9) is important for red blood cell formation and for healthy cell growth and function. The nutrient is crucial during early pregnancy to reduce the risk of birth defects of the brain and spine. The recommended daily amount of folate for adults is 400 micrograms (mcg). Women who are planning to become pregnant or who may become pregnant are recommended to consume 400 to 1,000 micrograms of folic acid daily.

Folic acid is mainly found in dark green leafy vegetables, beans, peas and nuts. Fruits rich in folate include oranges, lemons, bananas, melons, and strawberries. The synthetic form of folate is folic acid. It is an essential part of prenatal vitamins and is found in many fortified foods such as cereals and pasta.

What is the difference between folic acid and folate?

People often use the two interchangeably as they are both forms of vitamin B9, but actually there is an important difference. Folic acid is the synthesized version commonly found in processed foods and supplements. Folic acid is found in whole foods like leafy greens, eggs, and citrus fruits.

Research into the use of folic acid and oral folic acid supplements for certain medical conditions shows:

Birth defect.Research has shown that folic acid supplements can prevent birth defects of the neural tube. Taking a prenatal vitamin every day — ideally starting three months before conception — can help ensure women get enough of this essential nutrient.
folic acid deficiency.Dietary folate deficiency is treated with oral folic acid supplements. This type of deficiency is no longer a problem in many countries that fortify foods such as muesli and pasta with folic acid.
heart and blood vessel diseases and stroke.Folic acid works with vitamins B-6 and B-12 to control high levels of homocysteine in the blood. Elevated levels of homocysteine can increase your risk of heart and blood vessel disease (cardiovascular disease).
Krebs.Some research suggests that folate may reduce the risk of various types of cancer.
Depression.Some evidence suggests that folic acid may be helpful in treating depression.
Dementia.There is insufficient evidence to support folic acid supplementation for the prevention of dementia.

dr Chris D. Meletis explains how genetics can determine how well your body metabolizes vitamin B9

It's estimated that between 25 and 60 percent of the population have a variation in one of their MTHFR genes that negatively affects their ability to produce folic acid (the synthetic version of B9) and even some of the folate found naturally in food , to convert. into the active form of folate. If you are trying to conceive, you should consider having your genes tested to determine if you have the MTHFR genetic variation. The knowledge empowers you to make informed decisions about your individual nutritional needs, including whether you should choose prenatal and fertility supplements that contain the active methylfolate form of folic acid.

MTHFR converts synthetic to bioactive vitamin B9

Vitamin B9 occurs either in a synthetic form (folic acid), which is found in many vitamin supplements and fortified foods, or in a naturally occurring form in foods (folate). Both synthetic and most dietary folate that we ingest must be converted into the final bioactive form called L-methylfolate (also known as 5-MTHF) via a natural enzymatic pathway in our bodies. Once MTHF is formed, this active form of B9 can enter cells and cross the blood-brain barrier to nourish our tissues and brain. Successful conversion of folic acid or folate to MTHF depends on a converting enzyme known as MTHFR.

MTHFR is the cause of elevated homocysteine levels associated with frequent miscarriages

Homocysteine is a naturally occurring amino acid that is formed when proteins are broken down in the body. It's not harmful in low levels, but when present in high levels it can lead to a condition called hypercoagulability, in which your blood tends to clot more easily than it should. It's believed that women with elevated homocysteine levels are at greater risk of miscarriage, preeclampsia, and even preterm labor - most likely due to the increased clotting caused by the elevated homocysteine levels.

Why are homocysteine levels elevated? Methylfolate, the active form of folic acid, plays a role in converting homocysteine to methionine (a harmless amino acid). So when methylfolate is missing due to the MTHFR mutation and the resulting inability to convert folic acid to methylfolate, homocysteine levels can build up dangerously.

Researchers have discovered a link between high homocysteine levels and recurrent miscarriages, suggesting that MTHFR genetic variation may play a role in pregnancy loss.

The connection between MTHFR and PCOS

The most common specific condition causing infertility in women is polycystic ovary syndrome (PCOS). Women with PCOS are prone to hormonal and metabolic imbalances, including blood sugar dysregulation, also known as insulin resistance. These metabolic problems can lead to chronic anovulation (when the ovaries fail to release an egg during a menstrual cycle), oligomenorrhea (irregular periods), hyperandrogenism (too much testosterone), and insulin resistance. With such a wide range of fertility-related symptoms, it is not surprising that PCOS is a leading cause of infertility.

Many studies are being conducted to understand the underlying causes of PCOS. A 2014 study found an association between PCOS and MTHFR gene mutations, with researchers concluding that having a specific MTHFR mutation increases susceptibility to PCOS. The common thread between MTHFR and PCOS once again has to do with homocysteine levels. In general, the most common cause of elevated homocysteine levels (hyperhomocysteinemia) is decreased activity of MTHFR, resulting in decreased production of methylfolate. Women with PCOS typically test positive for higher levels of homocysteine than other healthier women. Many more studies are currently underway to determine the precise relationship between MTHFR and PCOS.

OurUltimate guide to fertility resourcesprovides the information you need about fertility, tips on how to get pregnant faster and how you can increase fertility with sometimes simple changes in your lifestyle and approach. The guide is easy to read and intended for anyone looking to increase their ability to conceive. It's a free download and includes coupon codes for major products. Even free nightfood Nighttime Ice Cream.

Would you like to know more?

Infertility 101: What you need to know first
male infertility
Female infertility
Medications for infertility

references

Folate (folic acid) Mayo Clinic
Effects of myo-inositol, gymnastic acid and L-methylfolate in patients with polycystic ovary syndrome.Gynecol Endocrinol.2017 Dez 21:1-7.
Maternal folate-, alcohol-, and energy-metabolism-related gene polymorphisms and the risk of recurrent pregnancy loss.J Dev Orig Health Dis.2012 Oct;3(5):327-32.
Association of methylenetetrahydrofolate reductase gene C677T polymorphism with risk of polycystic ovary syndrome: a systematic review and update of the meta-analysis.Eur J Obstet Gynecol Reprod Biol.January 2014;172:56-61.
The MTHFR-C6777T polymorphism is associated with hyperlipidemia in women with polycystic ovary syndrome. J Hum Reprod Sci. 2012 January-April; 591):52-56.
Association of maternal MTHFR C677T polymorphism with susceptibility to neural tube defects in offspring: evidence from 25 case-control studies. PLoS One 2012:7(10):e41689.