Prenatal Nutrients- The Folate Debate

This is the first in a series of articles getting into the nitty gritty of prenatal supplementation.  The main focus will be on nutrients that are becoming increasingly recommended through research but the response from compounding companies can be slow.  The nutrients that we are focusing on are folate, choline, Vitamin B12, Vitamin B6, betadine, Vitamin A, Vitamin D, Vitamin K, Glycine, Biotin and Omega 3.   There are several other nutrients that are also typically found in regular daily multivitamins that are ubiquitous in all supplements- so we will not worry about these.  The culmination of the series will be a comprehensive review of prenatal supplements, the good, the bad, the dirty and our top recommendations. 


Folate is the natural and bioavailable form of the synthetic folic acid.  Folic acid has long been a highly prescribed supplement for not only pregnant women but those even thinking about conception as adequate amounts in the mother has been shown to drastically reduce neural tube defects.  But first let us back up a little.  The main difference between the folic acid molecules lies in the chemical structure and how this is used by the body.  Unfortunately recent studies have shown that the cheaper synthetic (and most often prescribed) supplement form is inactive in its chemical form and some people may not be able to process it properly to the active 5-methyl-folate compound.  This inability to produce the active form is due to mutations in the MTHFR gene. [1]  The body contains 10-30mg of folate at any given time, the majority of which is stored in the liver. [2]

Due to this inability to process the synthetic form of folic acid it would be logical for mothers to be to supplement with the more available L-methyl-folate supplement to prevent the need for additional processing in the body.  Natural folate is also available through dietary sources such as dark leafy greens, legumes, eggs, organ meats such as liver and citrus fruits.  It wasn’t until the 1970’s when folic acid was industrial produced and it was available to add to supplements and food. [1]  Folate is now present in fortified grain products as it was made mandatory in 1998 in the USA, yet those whose diets do not include these foods should consider this when selecting their supplement. [1]  But why exactly in 1991 did the American FDA and the British MRC start scrutinizing the need for folic acid for women trying to conceive and pregnant? [3] Three words: Neural Tube Defects.

Folate has many functions in many key processes in the body- mainly the utilization of the amino acid methionine and as a cofactor (read as helper) in building DNA and RNA.  Newer research suggests it plays a role in the prevention of Alzheimer’s and anemia, some cancers and heart disease. [1]  In the developing fetus folate is essential for proper development of the neural tube.  How exactly folate helps to regulate correct development is unknown but the impact of proper supplementation has been well proven. [1]  This is formed when the future baby is still a lump of cells. The cells have just organized themselves into three layers and innermost layer will form the neural tube which eventually evolves to become the brain and spinal column. [4] Eventually this tube needs to close up like a Ziploc bag.  In humans several parts can start to close at once but when part of the tube is left exposed this results in a condition known as spina bifida, the severity of which depends on how much of the neural tube is left exposed.  If the “front” facing part of the tube is unable to close properly the forebrain is exposed to amniotic fluids and will shrink causing a condition known as anencephaly.   These conditions, although not common occur in 1/500 pregnancies. [4]  The research has shown that proper folate supplementation can drastically reduce the risk by 75%. [3]

Dosing amounts have been in a constant flux and argument as the studies continue to roll out.  Dosages range from 0.1mg to 0.8mg with the most common being around .4mg (400ug or 400mcg).  A final consensus is that folate from all sources (including food sources) should not exceed 1mg/day. [3] The NIH and IOH have suggested 0.6mg for pregnant women and 0.5mg for breastfeeding women.  This is drastically increased for women at high risk for a neural tube defect but you should contact your health provider for specific instructions [1]

Summary: Find a source of L-methyl-folate, or 5-methyl-folate that provides 0.6mg or 600ug/day if you are trying to conceive or are pregnant.

[1] J. e. a. Greenberg, “Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention,” Reviews in Obstetrics and Gynecology, pp. 52-59, 2001.
[2] N. I. o. Helath, “Folate- Dietary Supplement Fact Sheet,” NIH, Bethseda, MD, 2012.
[3] P. Suzanne White Junod, “Folic Acid Fortification: Fact and Folly,” Food and Drug Law Institute, 4 2001.
[4] G. SF, Developmental Biology. 6th edition., Sunderland, MA: Sinauer Associates, 2000.

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