You don’t hear much about folic acid until you’re trying to get pregnant, and then you start hearing about it all the time. Pretty much all prenatal vitamins share a common ingredient: folate or folic acid. As it turns out, you may want to start taking folic acid before you’re even pregnant. Here we’ll talk about what folic acid is, why you need it, and if you can eat it in food instead of taking it in pill form.
What is folic acid?
“A folic acid is a form of folate, which is a type of vitamin B,” Dr. Lucky Sekhon, fertility specialist and board-certified OB/GYN in New York City, says. “It is important for pregnant women as it prevents the occurrence of neural tube defects such as spina bifida.” Neural tube defects occur when the neural tube (which eventually makes up the spine, brain, and skull of a baby) does not properly fuse, causing the brain or spinal cord to have prolonged exposure to the amniotic fluid, which can result in certain birth defects.
Dr. Sekhon notes that folic acid is also important in forming red blood cells and the building blocks of DNA. She says that it may also help to reduce the risk of preterm birth and other types of birth defects, like cleft palate.
When do I need to start to get folic acid?
The general guideline is to start taking a prenatal with folic acid two to three months before you’d like to become pregnant, so the vitamin has time to build up in your body. “Women should take 400 to 800 mcg of folic acid per day,” Dr. Sekhon says.
It’s a good idea to take a prenatal through pregnancy and even after, especially if you plan to breastfeed. “You should continue your prenatal vitamin while breastfeeding as the metabolic demands are high, and you generally need more nutrition during this time to support the formation of red blood cells and to meet energy demands,” Dr. Sekhon says.
Are there different forms of the supplement?
It can be confusing when you see the word “folate” on some prenatal labels and “folic acid” on the other. To put it in its simplest terms, folate is the natural form of the vitamin (found in food), and folic acid is folate’s synthetic form, typically used in supplements, and it’s completely safe.
To further confuse matters, in certain prenatals, you may see MTHF or methyl folate instead of folic acid. MTHFR may sound like shorthand for my favorite swear word. Still, it’s actually a gene that works with folate to reduce the level of a potentially harmful amino acid called homocysteine. Variants in the MTHFR gene cause the body to convert homocysteine at a slower rate, and certain studies show that elevated levels of homocysteine may contribute to neural tube defects.
Because I was born with a cleft lip (a condition where the lip and sometimes the palate do not fuse together), I was actually tested to see if I have an MTHFR variant (it turns out I do not), though the mutation is fairly common, especially among the Latinx population, where it’s estimated that as much as 25% population have variants in both copies of the MTHFR gene, and Chinese women (another study found the variant present in one in three pregnant Chinese women).
The two most common MTHFR variants are known as C677T and A1298C. Some doctors may say that MTHFR is a more bioavailable form of folic acid (meaning it does not have to undergo an enzyme conversion) that is best for those with an MTHFR variant, though many do not agree with this.
Dr. Sekhon says, “there is no merit to the idea that some women should be taking alternate forms of folate,” and the CDC agrees. You may have heard or read that if you have an MTHFR C677T variant, you should take other types of folate (such as MTHF), but this is not true. According to the CDC’s guidelines, folic acid is the only type of folate shown to help prevent neural tube defects.
So even if you learn that you do have a variant (again, not uncommon), you probably don’t need to sweat what kind of folate you’re getting, just as long as you’re getting it in some form in your prenatal vitamin.
Can you get folic acid through food?
Even people who are not pregnant still need folic acid or folate because folate deficiencies have been linked to depression, allergic diseases, anemia and low bone density, per UVA Health. A folic acid is a synthetic form of folate that is used in supplements and in fortified foods (many foods in the US, including pre-packaged cereals and certain types of bread, are required to be fortified with certain vitamins). However, their requirements are often met through diet. Folate is found in eggs, avocado, leafy green vegetables such as lettuce and Brussel sprouts, and in fruits such as bananas or papaya. If you see on the packaging that a product is “enriched”, that generally means it is fortified with folate and other vitamins.
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