Everything You Need to Know About Folate for Pregnancy: Benefits, Differences, Deficiency, and Sources

You’re pregnant; congratulations! Along with the sudden energy drain you’re experiencing and managing morning sickness, your doctor is telling you that you need to increase your vitamin B9, or folate, or folic acid intake. But wait—which is it? Why is it important? Is it for you, for the baby, or both? 

Let’s dive into this key nutrient, its many forms, and how it can ultimately benefit you and your baby during pregnancy. 

Key Takeaways 

• Folic acid, folate, and folinic acid are all technically considered forms of vitamin B9—an essential nutrient.
• Dietary folate forms are either natural or synthesized, but that's not the real problem— the chemical form of Folate, Folic Acid, is the real potential troublemaker.
• 5-MTHF is the most biologically active form of folate.
• Folate is especially critical for a healthy pregnancy and healthy fetal brain development.
• We can only increase our folate levels through food or supplementation. 
• Bodybio Vitamin B+ contains a balanced high-potency formula of all the essential B vitamins—including folate—to synergistically provide metabolic, immune, brain, and cardiovascular support.*

What is Folate?

Folate is the active form of vitamin B9, part of the essential group of B vitamins all humans require for optimal health. Folate helps with methylation, a process that makes nutrients like lipids, amino acids, and even your DNA more bioavailable and functional in the body.[1]

Folate is also required to synthesize neurotransmitters like serotonin, norepinephrine, and dopamine, improving cognition and mood.[2]

Folate also helps regulate cobalamin or vitamin B12. In fact, both are essential to transform harmful homocysteine to beneficial amino acid methionine in the blood. B9 and B12 are so essential to each other's function that a deficiency of one will easily result in a deficiency in the other, leaving homocysteine levels high in the body, eventually resulting in heart disease and many other metabolic issues.[3]

Folate Benefits for Pregnancy

Folate is more important than ever during pregnancy due to the rapidly developing fetus’s demand for nutrition. Especially during the first several weeks of fetal development, the growing fetus requires abundant folate for neural tube development, among many other processes. When neural tubes don’t develop properly, it leads to conditions like spina bifida and anencephaly, when an infant is born missing major parts of the brain and skull. 

A 2015 study in the Journal of Clinical Pharmacology notes that while folic acid supplementation has been recommended for pregnant women for many years in order to reduce risk of neurological birth defects, it seems that many women are still not getting enough (at least .4 mg to 1.0 mg folic acid per day). They recommend increasing folic acid supplementation during the first trimester of pregnancy, especially for women who may have genetic predisposition to low folate or have had a baby with neural defects previously.[4]

However, as we will discuss next, folic acid is not the same as folate and may not be the best supplement for anyone with high folate needs, such as pregnant women. 

Folate vs. Folic Acid—Is Folate the Same as Folic Acid?

Folate and folic acid are used interchangeably to describe vitamin B9, but that is not completely accurate. Folate is found in whole foods and is metabolized by the intestinal mucosa. Folic acid is synthetic, is not found in nature, and is used to make cheap supplements and to fortify food. Folate is the real, nutritious vitamin B9 and is the only one you should get in your diet or via supplementation, especially if you are pregnant. 

For folic acid to be useful to the body, it is metabolized by the enzymes FOLR2 and DHFR, primarily in the liver. Natural folates, on the other hand, are handled by the gut. This means that your liver has to do a lot more processing to get folic acid to work for you performing its many metabolic functions. 

In addition, a large percentage—about 40%—of the population has a genetic predisposition that blocks the metabolization of folic acid in the liver. This genetic difficulty, the MTHFR gene variant, leads to a buildup that only increases homocysteine and lowers B12, exactly the problems we are trying to fix by supplementing with folic acid! 

While many countries have mandated folic acid food fortification to prevent the conditions associated with low folate, this is an inefficient approach and even a dangerous one for a high percentage of our population. Instead, we need to supplement and prioritize natural folate from whole foods and supplement with folate or folinic acid when appropriate, such as during pregnancy. 

Methylfolate vs. Folic Acid

Did you know that the word folate derives from the Latin word for leaf? Leafy vegetables are, in fact, one of the best dietary sources of folate. The name applies to a group of related compounds with similar nutritional properties. Levomefolic acid or 5-methyltetrahydrofolate (5-MTHF) is the active form of the folate you get from food.

The digestive system transforms food folate into 5-MTHF before it enters the bloodstream. As we previously discussed, unmethylated folic acid must undergo reduction with certain enzymes to become biologically active, meaning that when folic acid enters a cell, it needs to be converted into 5-MTHF before your body can use it. 

This enzymatic reduction can be hindered by the fact that many people carry gene variants that can hinder the last step of the conversion—you may have heard of the MTHFR gene variant. Combining that disadvantage with pregnancy as one of the highest drains on this essential nutrient, many pregnant women may struggle to get the full benefits of folate from folic acid.

Folinic Acid vs. Folic Acid

Let’s make this just a little more complicated, shall we? 

As we already know, folic acid is not an ideal form of vitamin B9 since it has to undergo processing in the liver to become bioavailable to the body. 

However, folinic acid, known as 5-formyl tetrahydrofolate, is a more bioavailable form of B9 for the body. It is already often used in medicine where the drug methotrexate is used in cancer therapy. Methotrexate is an anti-metabolite that interrupts the action of the reductase enzyme that guides the methylfolate processing pathway. Since folinic acid does not need enzyme activity for its conversion, its function as a nutrient is unaffected by enzyme inhibition.

Chemically, folinic acid is the active metabolite of folic acid; the prescription form is called leucovorin, a calcium-salt form acting as an antidote to the entities that block the conversion of folic acid to its usable metabolites. This makes folinic acid a much more beneficial supplement when taking vitamin B9 for a healthy pregnancy or simply for health maintenance. 

Folate Deficiency

Folate Deficiency Symptoms

Folate deficiency can cause anemia, poor reproductive health, and neural defects in babies.

While the cardiovascular and cancer risks of folate deficiency take some time to present, neural tube defects show up in only nine months or less. Among these are cephalic disorders that stem from damage to, or abnormal development of, the growing nervous system, usually occurring very early in pregnancy. 

After birth, the infant may be plagued by chronic illness, a physical disability or even death. In cases where disrupted closure of the neural tube occurs, a process that normally takes place between the 3rd and 4th weeks of pregnancy to form the brain and spinal cord, parts of the brain, skull and scalp are often absent. This condition, called anencephaly, results in an infant who is deaf, blind, unconscious, and unable to feel pain. It is a terrible and terrifying outcome.

Less drastic signs of folate deficiency may include fatigue, weakness, headaches, pale skin, breathlessness, muscle weakness, diarrhea, reduced sense of taste, and depression.[5] 

Folate Deficiency Causes

There are many causes of folate deficiency, but these are some of the most common. 

Poor diet. The Standard American Diet full of processed foods (even with folic acid!) does not provide enough natural folate to be processed and absorbed by the gut. Even with a whole food diet, some people with genetic discrepancies or increased folate demands still don’t get enough. 

Gastrointestinal disease. Since all of your nutrients from food are broken down and assimilated in the gut, gastrointestinal illness frequently robs the body of nutrients because of high demands from chronic inflammation and/or pathogens that steal the nutrients before we have a chance to use them. pH imbalance in the gut can also hinder folate absorption. 

Drug use. Medications such as methotrexate, phenytoin, sulfasalazine, and trimethoprim can block folate or inhibit its conversion to its active form in the body. 

Alcoholism. Among many other health issues, excessive consumption of alcohol hinders the liver’s ability to convert folic acid to folate. 

Pregnancy. As we’ve already discussed, pregnancy puts a massive demand on the body for folate, and pregnant women don’t get enough from diet alone. Folate supplementation is recommended during pregnancy, especially during the first trimester.[6]

How to Increase Folate Levels

Since your body does not endogenously make folate, we are left with two options to increase our folate levels: eat more folate-rich foods or supplement with bioavailable folate. 

Folate Foods

Foods that are naturally higher in folate include: 

• Leafy green vegetables– spinach, chard, arugula, etc. 
• Citrus fruits– oranges, lemons, limes, etc. 
• Beef liver
• Cruciferous vegetables– broccoli, asparagus, brussels sprouts, cauliflower, and more
• Eggs
• Seafood
• Avocado.

As much as possible, stay away from foods that are fortified with folic acid, including: 

• Conventionally processed grains, flours, breads, and cereals
• Conventional milk and non-dairy milk
• Many other processed packaged foods—always read your labels!

Still, with pregnancy or any of the other causes of folate deficiency above, it is important to supplement correctly in addition to a healthy diet. Let’s break down how to do that.[7]

Folate Supplements

By now you’re starting to understand that not all folate supplements are created equal, and there are thousands of them on the market today. So what should you look for in a good folate supplement? 

Folate or Folinic Acid, not Folic Acid. If you see folic acid in your B9 supplement, it’s not going to be beneficial for you (or baby, if you’re pregnant). Especially if you know you have the MTHFR gene variant, run the other way from folic acid. Remember, this includes fortified foods, so keep an eye on your intake! 

You want the bioavailable forms of folate or folinic acid. Keep an eye out for 5-methyltetrahydrofolate or 5-MTHF; this is a good bioavailable folate. 5-MTHF is the most biologically active form of folic acid/folate. It is well-absorbed, even when gastric pH is less than optimal, and its bioavailability is not compromised in the face of metabolic missteps. 

Don’t forget to double check your multivitamins and B complex vitamins for folic acid too.

Consider a B complex vitamin. B vitamins are really most effective when they are taken in combination, as they are often found in food sources. As we know in the case of folate and cobalamin or B12, they synergistically support each other and alternatively deplete each other when you are deficient in one or the other. 

The other B vitamins support each other’s function as well, so if you need more folate or any other of the B’s individually, give a well-rounded vitamin B complex a try.

Use multivitamins with caution. Most multivitamins on the market are cheaply produced and contain the detrimental folic acid, along with other inferior forms of the essential vitamins. For folate intake specifically, you’re better off going with a B complex. 

But, if you do need a multi, go for a high quality one with the bioavailable forms of the nutrients you need. It might be a little more expensive, but when you go for the cheap option, you’re basically throwing money out the window and contributing more harm to your overall health to boot. 

Bodybio Vitamin B+

Our high potency B complex formula only contains quality forms of B9 along with all of the other B vitamins: B1, B2, B3, B5, B6, Methyl B12, Folinic acid, 5-MTHF, and B7. This ensures that you get the highest possible benefit from your B’s, as they work synergistically in the body. 

Bodybio Vitamin B+ supports the metabolism, maintains healthy skin and muscles, supports immune and nervous system function, and combats the symptoms of stress.* It’s also the ideal supplement to support healthy fetal neural development in the first trimester and throughout pregnancy.*

When taking Bodybio Vitamin B+, you may notice increased energy, elevated mood, and an overall feeling of vitality.*

The Bottom Line on Folate

Folate, or vitamin B9, is an absolutely essential nutrient our bodies need every day, but we must be mindful of the many forms it comes in. While countries have been fortifying processed foods with folic acid for years, research shows that this inferior form may now be doing us more harm than good due to its need for extra processing in the body. 

This extra processing taxes the liver, and a person with the MTHFR genetic variation can not metabolize folic acid at all, leading to a build up of this inferior B9 in the body and eventually causing a deficiency in B12, another key nutrient. It is estimated that 40% of the population has this MTHFR variation in their genetic code. 

Folate is especially critical during the first trimester of pregnancy, to promote proper fetal neural tube development. The absence of folate can lead to severe neurological conditions such as spina bifida and anencephaly, or even death. Fortunately, these conditions are easily prevented with adequate supplementation of bioavailable folate and/or folinic acid along with a healthy balanced diet.