Folate and folic acid (often used interchangeably) are water-soluble B vitamins, also known as vitamin B9 (1). Folate is the naturally occurring form of vitamin B9, while folic acid is a man-made synthetic folate. Many foods are fortified with folic acid to prevent diet deficiencies such as enriched breads, cereals, flours, cornmeal, pastas, and rice (2).
Folate is a strong team player in numerous biological reactions. It helps form DNA, RNA, and metabolizes amino acids (1). Adequate folate intake can prevent serious birth defects, which is why it is important during pregnancy. Every year in the United States almost 3,000 pregnancies are affected by spina bifida or anencephaly, neural tube defects that arise from incomplete closing of the skull and spine early in pregnancy (3). These birth defects often take place before a woman knows that she is pregnant. The good news is that 50%-70% of these defects can be prevented if adequate folate is consumed before conception and throughout the first trimester (4). Mandatory fortification of cereal and grain products went into effect in January of 1998. From 1998-1999 the prevalence of spina bifida declined 31% while anencephaly declined 16%, a very successful preventative mandate.
Taking a folate supplement is the best way to prevent birth defects, but even better, taking the active form of folate ensures optimal absorption and bioavailability (5). Converting folic acid to the active form of folate requires a multi-step conversion process. For some mothers, a gene variant may prevent the successful conversion of folic acid to the active form of folate, leading to an increased risk of birth defects. In the United States, about 25% of Hispanics and 10%-15% of Caucasians have these gene variants (6). The best way to ensure optimal utilization is to take a supplement that offers “active” or “methylated” folate.
Recommended intakes of folate are 400 mcg per day pre-pregnancy, 600 mcg per day during pregnancy, and 500 mcg per day during the lactating period (1). Besides fortified sources, natural sources of folate are found in spinach, asparagus, Brussels sprouts, lettuce, broccoli, mustard greens, green peas, black-eyed peas, kidney beans, peanuts, oranges, bananas, and eggs. By eating a balanced diet and supplementing throughout your pregnancy, you can provide a nourishing environment for your baby to thrive in.
- National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/. Updated April 20, 2016. Accessed December 8, 2017.
- Folic acid in diet. National Institutes of Health MedlinePlus. Reviewed May 7, 2017. Accessed December 8, 2017.
- Data and Statistics: Folic Acid. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/folicacid/data.html. Reviewed November 8, 2017. Accessed December 8, 2017.
- Spina Bifida and Anencephaly Before and After Folic Acid Mandate — United States, 1995—1996 and 1999—2000. Centers for Disease Control and Prevention MMWR Weekly. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm. Published May 6, 2004. Accessed December 8, 2017.
- Lamers Y, Prinz-langenohl R, Brämswig S, Pietrzik K. Red blood cell folate concentrations increase more after supplementation with [6S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. Am J Clin Nutr. 2006;84(1):156-61.
- MTHFR gene variant. National Center for Advancing Translational Sciences. https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-mutation. Updated September 22, 2017. Accessed December 8, 2017.