what’s in your prenatal?

Today, our dietitian Sarah Becker MS RD is taking us to school on all things folic acid and folate.

Let’s start with the TL;DR (too long, didn’t read it): Regardless of your genetics, the type of folate you take is important. Make sure your prenatal has methylated B vitamins in it. 

Turn over your prenatal or multivitamin bottle and take a peek at the label. Does it have folic acid or folate?

Folate, also known as B9, is one of eight water-soluble B-vitamins. Our body cannot store B-vitamins, rather we use what we can and pee out the rest. Ever have bright yellow or neon urine? That’s your body eliminating excess vitamins that it cannot use. And don’t worry, it’s totally normal. Folate is an essential vitamin, meaning our bodies cannot make it. Instead, we get it from the food we eat or from taking a supplement. If supplementing, this is where things can get tricky. 

Folic acid is synthetic, meaning it’s man-made and not formed in nature. It’s important to note that not everyone can absorb folic acid well. On the other hand, folate is the naturally occurring form found in foods. Most supplements use folic acid because it’s a lot cheaper.

Even though research is changing, The American College of Obstetrics and Gynecology (ACOG) and Centers for Disease Control (CDC) continue to recommend folic acid, the synthetic form. At Indigo we believe that folate is superior to folic acid. Read on to find out why.

Why is folate important during conception and beyond?

Folate plays an important role in fertility and pregnancy, for both mom and growing baby. In the initial weeks of gestation, folate is critical for the formation of the baby's neural tube. In babies, folate deficiency is linked to neural tube defects, reduced placental development and preterm birth. In moms, deficiency is linked to anemia and peripheral neuropathy. 

What’s the deal with MTHFR?

Neither folate or folic acid is available for the body to use. Instead, it has to be broken down and converted to a usable form first. This conversion is made possible with an enzyme called Methylene-tetrahydro-folate Reductase, otherwise known as MTHFR. The conversion happens in the liver. Once active, B9 can be used in the body! The usable form is called L-methylfolate or 5-methyltetrahydrofolate (5-MTHF). 

We all have the MTHFR enzyme but some of us have a variation in the MTHFR gene that doesn’t allow the conversion process to take place. It’s estimated that up to 60% of people can’t use folic acid due to genetics.

What if I don’t have the MTHFR variant, does it matter what form I take?

Unless you’ve done genetic testing, you won’t know whether or not you have the MTHFR variant. With more than half of the population with this variant, it makes sense to use the active form. In addition, the body can only use so much folic acid. Studies have shown that unmetabolized folic acid (aka folic acid that isn’t broken down) can build up in the blood and even pass to your baby. In newborns, unused folic acid may negatively impact their immune system, lead to developmental delay and infant asthma. The jury is still out on the side effects of unmetabolized folic acid but this can be avoided with supplementation of the natural form. 

What are the best food sources?

Our team of dietitians have a food first approach, yet during pregnancy supplementation is critical. We make sure all of our mommas are on methylated B vitamins. Foods high in folate are green leafy vegetables, legumes, liver, avocados, eggs, nuts and seeds. The good news is that the majority of food sources are already in the active form. Our bodies can absorb and utilize the nutrients regardless of genetics, no conversion needed. 

Why is my OB still recommending folic acid?

New research suggests that folate is better for fertility and pregnancy. So why is your OB still recommending folic acid? The short answer, research is lagging behind. The majority of studies have used folic acid, not folate and unfortunately, it takes a long time for official recommendations and guidelines to change. This doesn’t mean it’s the right choice.

What does the research say?

In a study following women during pregnancy, one group used a prenatal with 400 mcg folic acid and the other used a prenatal with 418 mcg of L-methylfolate, the active form. The group using the active form had higher levels of folate in their blood at the end of the second trimester and at the time of delivery. These moms also had a lower incidence of anemia. Folic acid can mask a B12 deficiency while folate does not.

Folate and homocysteine levels are also linked. The more folate in your blood, the lower homocysteine levels you have. Elevated homocysteine has been found with folic acid supplementation. This is problematic because elevated levels during pregnancy may lead to higher risk of miscarriage, preeclampsia and preterm labor. 

What should I look out for in a multivitamin or prenatal?

Be sure you’re supplementing with methylated vitamins. If taking a B-complex, some bottles may use the language “activated” B-vitamins. In a prenatal, be sure the label says L-methylfolate or 5-methyltetrahydrofolate, sometimes seen as 5-MTHF.

Indigo’s Top Recommended Prenatal Vitamins

Need a prenatal recommendation? These are Indigo’s top picks:

• Needed Multi or Needed Multi Essentials

• WeNatal 

• Thorne Basic Prenatal 

Want to optimize nutrition for fertility and pregnancy? Book a session with our Indigo dietitians!