We see you, momma. You’re trying to conceive, or are already pregnant, and part of your preparation includes practically going blind trying to read every book and blog under the sun about how to get pregnant, what the signs of pregnancy are and how to get the birth you want. Pregnancy is hard. You’re GROWING A TINY HUMAN, but keep the faith! If you’re trying to get pregnant, or you think you’re experiencing symptoms of pregnancy, it’s important that you do your research on the best prenatal vitamins and start taking them right away! When analyzing what is the best prenatal vitamin to take, know whether you should take folic acid versus folate and what to consider if you have the MTHFR mutation.
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It’s estimated that one in 33 babies are born with a birth defect and with the right nutrition, many of these birth defects are preventable. To jump start your search for the best nutritional support and prenatal vitamin, we are focusing primarily on a very important nutrient during pregnancy, vitamin B9. This vitamin has been clinically shown to prevent neural tube defects (NTDs), which are birth defects that affect the spinal cord and brain development. Vitamin B9 can be found in two different forms: the form that is most commonly found in prenatal vitamins is known as folic acid and the other is folate. But which version of vitamin B9 should you take, folic acid or folate? What’s the difference and what are the risks to you or your baby if you don’t get enough?
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If you and your partner are trying ways to get pregnant, you likely have done your research into some of the best prenatal vitamins that help support a growing fetus and supplement the nutritional gap of your dietary intake. You’ve found by now that not all prenatal vitamins are created equal and many use low to no quality ingredients. During pregnancy, you know there are a few essential vitamins all pregnant women need to include in their prenatal diets. One of the most important nutrients that has been clinically studied for years and has been shown to decrease the risk of neural tubular defects is vitamin B9. Before delving into the differences between the synthetic (folic acid) and natural form (folate) of vitamin B9 and discussing its critical role in your baby’s development, let’s review a few key studies that will give us a better understanding of the critical role vitamin B9 plays during fetal brain development and how it can minimize neural tube defects by as much as 70% if taken 2-3 months before conception (1) The mandatory folic acid fortification in the United States in the late 1990s, led to a 19% reduction in neural tube defects (2). Another study that was updated in 2015, found that in countries who do not fortify their rice with folic acid had a 3-5x higher percentage of births with neural tube defects (3).
What Are Neural Tube Defects and When Do They Occur?
Neural tube defects are birth defects that affect the brain and spinal cord. The neural tube forms in the first 4 weeks of pregnancy and sets the stage for the later development of the nervous system and brain. The most common neural tube defects are spina bifida and anencephaly. Spina bifida is when the fetal spinal column doesn't close completely and despite many advances in medicine, the life expectancy is only 30-40 years and typically ends in renal failure. The key here is that most women do not know they are pregnant in the first 4 weeks of pregnancy. In fact, the hormone, Human Chorionic Gonadotropin (HCG), also known as the ‘pregnancy hormone’ because it is what pregnancy tests are detecting, does not spike until about 60-90 days after conception. Given that the neural tube has already formed by 28 days after conception, there is nothing that can be done to reverse this problem. That is why it is so critical that women are getting enough vitamin B9 in their diets at least one month before conception and two months after conception.
There is some comfort in knowing that the United States government mandated the fortification of enriched cereal grain products with folic acid starting in 1996 and it was fully implemented by 1998. One study found it to have resulted in a 19% decrease of neural tube defects in the years following the mandate, however, there may be more to this story. In fact, there are some studies that suggest folic acid may have adverse health outcomes including cognitive function (4).
Should I Take Folate Instead of Folic Acid?
Folic acid is synthetically made and folate is naturally occurring. It’s estimated that about 40-60% of the population has a mutation on the MTHFR gene, which is the gene that breaks down folic acid and turns it into a usable form of vitamin B9, methylfolate. To make things worse, it’s estimated that if you have this MTHFR gene mutation, your body can be up to 80% less efficient in converting the folic acid which is used for DNA methylation, the process of turning certain genes off and on. Without knowing whether you have this mutation or not, there is still a high probability that your body will not be able to use the folic acid to its fullest potential and possibly putting your fetus at risk because if your body can not convert the folic acid into a usable form, it’s as if you aren’t taking anything at all. The best prenatal vitamins mitigate the possibility that your body will not be able to utilize the synthetic folic acid and have opted to use natural folate instead.
Pregnancy is a beautiful, wonderful time in your life and the choices you make in regards to your health and nutrition are critical building blocks for your baby’s health. When you start looking at prenatal vitamins and other nutritional supplementation, be sure that you look for brands that use the most natural and bioavailable ingredients and this is especially important now given all that we’re still learning about the MTHFR mutation and how the body processes folic acid versus folate.
MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991;338(8760):131–7. [PubMed]
Impact of Folic Acid Fortification of the US Food Supply on the Occurrence of Neural Tube Defects. JAMA. 2001;285(23):2981-2986. doi:10.1001/jama.285.23.2981 [JAMA Network]
Excessive folic acid intake and relation to adverse health outcome. Biochimie. 2016 Jul;126:71-8. doi: 10.1016/j.biochi.2016.04.010. Epub 2016 Apr 27.