When it comes to pregnancy nutrition, the debate between folate and folic acid is a common concern for many expectant mothers. To shed light on this important topic, we consulted with Lola Biggs, an in-house registered dietitian at Together Health. With her expertise, Lola answers all your pressing questions about the differences between folate and folic acid, their roles in prenatal health, and how to ensure you’re getting the right nutrients for a healthy pregnancy. Read on to discover the essential information you need to make informed choices for you and your baby.

Can you explain the difference between folate and folic acid, specifically in the context of pregnancy?

You can often find the terms ‘folate,’ ‘folic acid,’ and ‘vitamin B9’ being used interchangeably, especially the first two; although these terms are related, there are key differences. Vitamin B9 and folate are umbrella terms used for all forms of this vitamin; different forms of a vitamin are referred to as vitamers. However, colloquially, folate refers to a group of vitamins that exist naturally in foods. Folic acid refers to a specific synthetic form that does not exist in nature.

Folic acid must be metabolised to be utilised safely and high intakes of the synthetic form may lead to increased blood levels. Some researchers speculate that this may have adverse health effects over time. Whole food naturally occurring folate can often be described as poorly absorbed due to it being bound within the food, luckily there is an abundance of natural food sources, and most people will get enough from a balanced diet rich in fruits and vegetables and whole grains.

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Both kinds are used by your body to make new cells and create DNA and are required for normal growth and development throughout your life, and evermore so during pregnancy. Increased levels are needed for both the mother and the baby when pregnant, and adequate levels must be available before and during pregnancy to sustain normal and healthy growth of the baby and the health of the mother. It is therefore recommended in the UK to take an additional 400mcg supplement before and throughout pregnancy alongside a balanced diet.

How does the body’s absorption and utilisation of folate differ from that of folic acid during pregnancy?

Unlike natural folate, folic acid is not inherently methylated, which means the body has to take an additional step to do this, whether you are pregnant or not. There can be a number of variables that can alter the efficacy of this process, with the most part relying on an enzyme-specific reaction, which can be influenced by several factors, including a gene mutation for that specific enzyme pathway.

Folate is processed in the digestive tract. However, folic acid requires a two-step process in the liver and other tissues. Limitations in our body’s ability to process folic acid result in unmetabolised folic acid in the bloodstream.

What happens to unmetabolised folic acid in the bloodstream?

If this does happen, the increased levels of unmetabolised folic acid (UMFA) in the bloodstream, which is not being utilised may be linked to some adverse effects as mentioned above. The implications of unmetabolised folic acid are not yet understood, and calls for more research are often made, Still, it has been linked to worrying side effects that could affect the immune system, damage the liver and even promote cancer. There are no such concerns with folate. Unlike folic acid, there is no upper limit set for folate intake, as high folate intakes have not been reported to cause adverse effects.

Further, a high level of circulating unmetabolised folic acid can mask a potential deficiency of the essential vitamin B12; it is important not to supplement more than 1g a day.

Conversely, even with Folate being abundant in several healthy foods and in its preferred converted form, being bound in foods can make it harder to absorb, so taking an active folate supplement is still recommended throughout all stages of pregnancy.

Look for complete supplements using leafy vegetables like spinach as the source. These contain bioactive co-nutrients, B9 in its methylated state, with all active forms of folate

Why is folic acid supplementation recommended for pregnant women/those TTC (trying to conceive)?

This vitamin plays a vital role is for new growth, from making new red blood cells to DNA synthesis. Therefore, having an adequate supply in the early or preparation stages reduces the risk of any abnormal cell development in the early foetus.

The early stages of pregnancy are when most of the cell differentiation takes place, requiring a lot of DNA production. This stage is when the formation of the spinal cord takes place, and this is when folate vitamin is required the most. Early gestation may not always be immediately determined, and early stages of pregnancy can go undiscovered.

To cover the health risks associated with low folate and its inability to be stored in the body, it is recommended to supplement your diet with a 400mcg dose of B9 if you are looking to conceive or as soon as you know you are expecting.

What are the main benefits of folate for fetal development?

Having an optimum supply of Folate helps to ensure normal cell development and growth for the baby, especially in the early gestation period. It is also crucial for supporting the creation of new blood cells for both mother and baby, as vascular needs increase. The vitamin also supports the production of amino acids, the protein building blocks for the baby. Evidence has shown that preventing folate deficiency in the early stages of the pregnancy can help prevent birth defects.

How does adequate folate intake help prevent neural tube defects?

It is an essential vitamin needed during the first trimester to form the required abundance of DNA and cells, which are the building blocks for the baby’s brain and spinal cord. If there is not an adequate amount, this can limit the new foetus’s ability to form a healthy neural tube.

Are there other developmental benefits of folate for the baby?

As part of the B vitamins umbrella, it works with B12 and B6 to maintain healthy blood levels and metabolism of the baby as it goes through its growth cycles.

What are the potential risks of folate deficiency during pregnancy for both the mother and the baby?

If the mother and subsequently her baby don’t obtain the required supply and utilisation of Folate both are at risk. The mother can develop peripheral nerve damage and anaemia, and the baby could suffer a life-risking birth defect (Neural tube defects include spina bifida and anencephaly) which may result in premature birth with reduced birth weight and lasting health issues surrounding restricted development.

Are there any side effects or risks associated with excessive intake of folic acid during pregnancy?

Although folic acid is water soluble and is not stored in the body, any excess has to be filtered out by the kidneys, so if any kidney issues are present this may cause an unnecessary burden. There also can be problems with having high levels of UMF in the bloodstream.

It can mask low levels of B12 or/and more severe, an underlying B12 deficiency, which can cause irreversible neuropathy and anaemia if undiagnosed. Some adverse health concerns are also associated with excess UMA, although the evidence is not 100% conclusive.

What are the best natural dietary sources of folate for pregnant women?

Think ‘foliage’ for green leafy vegetables, and cruciferous veggies. Citrus fruits are also a great source, as well as pulses and eggs, and you may see cereals and grains with ‘added folic acid’ this is a fortified man-made source. Whole food sources of folate will always have other nutrients that support both mother and baby through the pregnancy.

How much folate/folic acid should pregnant women ideally consume daily?

Aiming for a balanced diet of wholegrains and 5 portions of fruits and vegetables will keep food folate sources high, but it is important to also include 400mcg a day in supplement form, ideally one that is highly absorbed and contains all active folates, including 5-MTHF.

Some pregnancies have a higher risk of being affected by a neural tube defect and in these situations, your doctor will recommend taking a higher dose, this will be agreed with your GP.

Should pregnant women rely more on natural sources of folate or on supplements, and why?

I recommend looking to include folate-rich foods into your diet. Think ‘foliage’ and reach for lots of green leafy and cruciferous vegetables, such as broccoli, cabbage, kale, spring greens and spinach.

We do not store this vitamin, so it is important to reach for sources each day, and that is why taking a supplement version can be a vital safety blanket. Look for those natural supplements from spinach extract that contain all the active folates, including 5-MTHF and with a dose of 400mcg a day. Together Health’s Folate supplement, £7.99 is perfect. It’s 100% natural folate including 5-MTHF and contains the recommended 400 mcg dose for pregnancy and is made from spinach grown without any artificial pesticides or herbicides.

Are there any specific dietary guidelines for folate intake before conception and during early pregnancy?

Guidelines advise striving for a well-balanced diet when thinking of conceiving and maintaining throughout pregnancy, which should provide good levels of natural folate.

It is recommended to be extra mindful to include ample sources such as green leafy and cruciferous veggies, nuts and seeds, pulses and beans, and citrus fruits and eggs. However, even with a balanced diet, health guidelines still recommend an additional 400mcg supplementation both before and during the pregnancy as a safety net, due to the associated risks surrounding deficiency and low levels to both mother and baby during this time and the chances of conceiving and not knowing in the early stages.

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