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If you’re pregnant or trying to become pregnant, you’ve probably heard it once or twice (or a million times over): you need to get enough folate in pregnancy. Folate, also called “B-9,” is a vitamin that helps with many key processes in the body, including cell growth and DNA formation. You can find it in foods like mushrooms, legumes, green leafy vegetables like kale, and fruits like oranges, bananas, and melons. More commonly, though, people take it as a supplement or as part of a multivitamin — like your trusty prenatal.
The problem is this: it’s hard to know if you’re getting enough and if your body is absorbing all that’s in your vitamin. We interviewed an Expectful nutritionist to find out why you need it and a breakdown of the different forms you’ll see in supplements. Plus, we share the ultimate testing tool to ensure you’re getting enough throughout your pregnancy.
Why is it so important to get this micronutrient? Folate assists and facilitates many key processes in the body, including helping the body break down proteins, perform cell division, and make healthy red blood cells.
In pregnancy, though, it has one of the most critical jobs: helping your baby’s brain develop.
It’s absolutely essential that you are getting enough folate in the early days and weeks of pregnancy. This is because “folate plays a central role in preventing neural tube defects in the fetus,” explains Tamsin Jordan, a nutritionist specializing in women’s health who works with Expectful. The neural tube forms between days 21-28 of pregnancy and later becomes the spine, brain, and skull of the fetus. Folate’s role in helping this area develop appropriately is crucial.
Because of the importance in early fetal development, your doctor or midwife will recommend you take a prenatal vitamin with folate three months (or even longer) before you try to conceive. In fact, the US Preventative Services Task Force recommends that all women capable of pregnancy take a daily supplement regardless of whether or not they are actively trying to become pregnant. This is so that whenever pregnancy happens for you, whether planned or not, you’ll have a healthy source of folate on board for those uber-important early days of neural tube development.
When scanning the labels of vitamins, you’ve probably seen the term “folic acid” or maybe even “methylfolate.” These are non-food forms of folate commonly found in pharmaceuticals and nutritional supplements.
Folic acid: A generic term referring to the form of folate used in supplements. Some foods like bread are also fortified with folic acid (these are often labeled as “enriched”). This is often a cheaper form of folate.
Methylfolate: Also known as 5-methyltetrahydrofolate, the most “activated” or bioavailable form of folate and is often easier for people to process in their bodies. It can be a more expensive form of folate.
Folic acid is a common form of folate and is safe for many people to ingest regularly. It is the most commonly used form of folate and is found in many of the widely-available multivitamins and prenatal vitamins on the market. Once folic acid is ingested, the body must convert it to the active form of folate — methylfolate — before it can use it appropriately and to its full benefit. Almost all people have the capability to make that conversion.
Now, it’s important to address something you may or may not have already heard about — MTHFR (methylenetetrahydrofolate reductase) “mutations” or “gene variants.” Affecting 30% to 40% of the population, this variation may make it more difficult for a body to convert folic acid into folate. Because of this, a body may have a more difficult time converting folic acid to the active form of folate, which can lead to lower levels of this vital nutrient.
So the theory is that those with the MTHFR variant are better able to process the folate in methylfolate, the already converted, active form, rather than starting with folic acid and doing the conversion themselves. When anyone takes methyfolate over folic acid, the body gets the active form right away and there is no need to convert. So, it’s easier to use and absorb from the beginning.
But what does the data say about this? Well, it’s a mixed bag. There’s a correlation with miscarriages and neural tube defects in some studies, while other studies refute that the most common MTHFR variants play a role in folate synthesis problems. Because of the lack of clear, causal data, the National Institute of Health has not yet recommended doing anything different in terms of folate supplementation based on MTHFR status.
Don’t worry—most people do not have MTHFR gene variants. And because the nutrient is not regularly tested for deficiency, those who do have MTHFR gene variants likely do not even know. The good news is that they tend to live fully healthy lives, with no issues relating to folate deficiencies.
Long story short? Taking a folate supplement is always, always, always a good idea.
Food can be a source of much of the healthy folate you consume. Foods like leafy greens, fruits, legumes, mushrooms, and avocados are all rich sources of folate and can be easy to incorporate into many of your meals, from smoothies to soups. All of these foods can be part of a well-rounded diet throughout your pregnancy.
However, nutritionist Jordan explains that, “It is important to note that 50-80% of folate can be lost in food preparation by heat, oxidation, and ultraviolet light. For that reason, raw foods are higher in folate than cooked foods.” So if you’re aiming for lots of folate in your diet, uncooked foods (like salads!) are probably the best way to go.
For most people, taking a supplement is the easiest way to ensure adequate folate intake. In general, most prenatal vitamins will contain enough folic acid or methylfolate for your daily intake requirements. The CDC recommends that all women who could become pregnant take 400 mcg – 800 mcg (micrograms) of folate per day, in addition to consuming food with folate in it. Jordan suggest taking your supplements with or right after a meal to decrease any nausea.
Supplement Taking Tip: Try to take your vitamins with or right after a meal to decrease any nausea.
Now that you know why folate is so important, your next step can be to test yourself for the nutrient. It’s now easier than ever to make sure you’re getting the recommended amount through an online-purchased test and sample collection.
According to Labcorp, a global life sciences company that is a leader in diagnostic testing, “Pregnant women and women who are breastfeeding have increased demand for folate. Failure to meet this increased demand can result in a deficiency.” That’s why they’ve developed a simple, accessible way to get tested and make sure you don’t fall into too-low a range during such a pivotal time. It’s called the Vitamin B12 and Folate Blood Test, and you can access it without having to visit a doctor.
The process is straightforward: after selecting the folate test on their site, you give a small blood sample at your local Labcorp.. Then voilá — you can soon access your results online. Find your results, with the convenience of choosing when and where you get tested.
In addition to testing yourself, it’s important to take the right prenatal vitamin.
Every prenatal vitamin on the market will have a form of folate. Overall, choosing a prenatal vitamin with 800-1000mcg of the nutrient is the way to go, according to Jordan. “Some supplements will also have additional calcium folinate (folinic acid) which can help increase absorption and tolerance,” she adds. While this is a great guide, we recommend consulting your doctor or midwife on the appropriate dosage for you.
However you get your folate, be sure to take it before and during pregnancy. Adequate folate will help contribute to a healthy pregnancy for both you and your baby.
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