The truth about folic acid for prenatal nutrition
When you think about how to prepare for pregnancy, what kinds of things come to mind? Most people consider the size and location of their home, getting finances in order, looking at bigger cars, and parental leave. But what about nutrition?
As pregnancy requires extra nutrients to support mom and baby, prenatal vitamins are the universal recommendation of doctors and midwives once a woman is pregnant. This whole practice seems pretty straightforward, but there’s a lot of confusion and even misinformation about what to take and when to start taking it.
Many doctors will suggest beginning to take prenatal vitamins 1-3 months before trying to conceive, and many wellness experts will recommend making health changes in the 6-12 months before pregnancy. Beyond cleaning up your bad habits and improving your diet, beginning prenatal vitamins with the correct ingredients for you can be critical but we often aren’t told the what or why.
One critical reason for prenatal supplements is the need for Vitamin B9 (referred to folate or folic acid) due to its well-studied ability to help prevent miscarriage and neural tube defects, including Spina Bifida. Most women don’t get enough folate (food form of the vitamin) in their diet, and their needs double in pregnancy.
What many people don’t know is that the neural tube forms in the first month of pregnancy, and stores of folate in the body before conception have been shown to have the greatest benefit in preventing defects. March of Dimes suggest 400-600mcg of B9 in diet and supplements daily for all women of childbearing age. For women try to conceive it’s recommended for at minimum one month before pregnancy.
So, while this critical need for B9 before pregnancy should be highly emphasized for pre-conception preparations, wouldn’t you think that doctors would also be pushing folate-rich foods, such as legumes, avocado, spinach, broccoli, and more? But the only term you ever hear about is “folic acid” and we all assume it’s taken care of with a prenatal vitamin. But why?
In the 1940s, after the discovery of this connection between B9 and neural tube defects, a cheaper, synthetic form of folate was developed called folic acid, to make it easier to add to supplements and foods. And over time it was added to many processed foods (breads, cereals, pastas, and more) because of its protective effect across the population. It became a “mandatory food fortification” in 1998.
So between low-cost prenatal vitamins fortified with folic acid and forced supplementation in processed foods, it seems that the problem of neural tube defects and related miscarriages has been well-handled. However, this is sadly another case of discovering the unintended consequences of synthetic and genetically modified nutrients.
What we now know is that between 25 and 60 percent of the population have a genetic variation in the genes referred to as MTHFR that negatively impacts their ability to convert folic acid into the active form of folate. (American Pregnancy Association) What happens then is this inability to convert folic acid to methylfolate creates dangerous levels of the amino acid homocysteine.
Researchers have discovered an association between high homocysteine levels and recurrent miscarriage, which suggests that the MTHFR genetic variation may play a role in pregnancy loss. Women with elevated homocysteine levels are also believed to be at higher risk for preeclampsia and even preterm labor – most likely due to the increased clotting caused by the elevated homocysteine levels.
So, if a pregnant woman with this genetic mutation is taking a prenatal vitamin with large doses of folic acid every day, and eating conventional processed foods, she is not only not protecting her unborn child from neural tube defects and miscarriage, but she is essentially poisoning herself by taking the prenatal vitamins she was told would protect her baby. What was meant as a helpful vitamin has become a dangerous and hidden toxin.
I feel very fortunate that in the year before my first pregnancy, I worked with an amazing doctor who gave me access to all kinds of information including genetic testing that alerted me to my own MTHFR mutation. She armed me with a wealth of knowledge and the right nutrition and supplements for my unique needs. (I’ll share more about that in another article.) But not everyone can get genetic testing and personalized plans for nutrition and supplements to prevent problems in their pregnancies.
If you are trying to get pregnant, consider getting tested to determine if you have a MTHFR genetic variation. But if genetic testing isn’t possible, then you can still safeguard your health. I stand with the American Pregnancy Association’s recommendation that women get folate from whole food sources and supplements containing the natural form of active folate instead of synthetic folic acid.
There are many doctors and health companies beginning to help their patients and customers navigate this issue, so talk to your doctor about your supplements and diet. But as a fair warning, there are unfortunately many in the medical community are still unknowledgeable about this. And with the industry behind the tradition of folic acid and its continued production and supplementation, regardless of individual needs, it’s no wonder that this newer research hasn’t been universally adopted.
There are a few options for prenatal vitamins with folate on the market, but the only one I can recommend without reservations is the Garden of Life Vitamin Code Raw Prenatal Multivitamin. In addition to a variety of important nutrients (vitamins A, C, D, and E, as well as iron, biotin, manganese, probiotics, ginger, and zinc for digestive support), these multivitamins contain 200 percent of your daily folate needs when you take the recommended three capsules per day. There are more nutritional needs in pregnancy that what can be found in just one supplement, but more on that another day.
In the end, there are no true, side-effect free shortcuts for excellent prenatal nutrition. As we navigate modern healthcare and food technology, we each have to be our own best advocates and critical thinkers. No doctor, nurse, dietitian, or blogger can make your choices for you. So please, stay aware, and I hope you find the best nutrition for your precious prenatal health journey.
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