Folic acid in pregnancy: everything you need to know

Vitamin B9 (folic acid or folate) is an essential and indispensable vitamin for the body. Folates are involved in many biological functions, including cell division and DNA synthesis [1]. During pregnancy, these processes are particularly crucial for ensuring the healthy growth of the foetus.

Folates are also very important for the formation of red and white blood cells [2]. They also play a role in the functioning of the nervous and immune systems [3].

From conception, this vitamin actively contributes to the formation of the neural tube, which will develop into the baby's brain and spinal cord. Folic acid is therefore prescribed as a preventive measure, to reduce the risk of neural tube defects. Indeed, one study showed that a daily periconceptional intake of 400 µg of folic acid in women reduces the risk of neural tube defects by approximately 60% [4]. Another study demonstrated a protective effect of 72% [5]. 

Furthermore, it is also beneficial for fertility. Studies suggest that folates may have beneficial effects on fertility, acting on the quality of eggs and embryos [6].

According to the SU.VI.MAX study, three quarters of women have intakes below recommended levels. 

A vitamin B9 deficiency could lead to neural tube defects in the unborn child [7]. Inadequate folate status in the mother has also been associated with low birth weight, premature delivery, and foetal growth restriction [8]. Furthermore, elevated homocysteine levels (present when intake is insufficient) are associated with recurrent spontaneous miscarriage [9], as well as an increased risk of placental rupture or abruption [10].

In general, the consequences of folate deficiency are linked to its role in DNA synthesis. A deficit can lead to a reduction in cell multiplication, particularly in the renewal of red and white blood cells, and intestinal and hepatic cells [11].

A deficiency occurs when the concentration of folates in red blood cells falls below 100 µg/L. A moderate deficiency is identified when values are between 100 and 200 µg/L [12].

It is recommended to start supplementing at the beginning of pregnancy and even a few months before. Indeed, this developmental anomaly occurs during the 4th week of pregnancy — in other words, before most women even know they are pregnant! 

To this end, international guidelines recommend supplementation of 400 µg in the form of a medicine or food supplement, 4 weeks before conception and 8 weeks after, in addition to an optimised diet rich in dietary folates. 

Vitamin B9 or methylated folate (5-mthf) on your plate

Methylated folate (5-mthf) is found in food, particularly green leafy vegetables, fruit, pulses, liver and brewer’s yeast. However, dietary methylated folate (5-mthf) is not very stable and does not withstand light or heat well. Up to 30 % of naturally occurring methylated folate (5-mthf) can be lost during food preparation, depending on the cooking method used [13].

For example, steaming causes virtually no loss, unlike boiling.

Vitamin B9 in food supplements

The difference between folic acid and methylfolates

The form of vitamin B9 that the body absorbs and uses is its active form. It is called the "methylated form" or "methylfolate". 

Folic acid is a synthetic, non-methylated form. Once folic acid has been absorbed, a series of transformations produces the active forms of vitamin B9. 

Converting folic acid into methylated folate (5-mthf) requires more than 7 functioning genes and more than 7 functioning enzymes. It also requires nutritional cofactors (nutrients needed for the enzymes to function) and a healthy environment (low levels of heavy metals, infections, toxins, etc.). These reactions are very slow and can also quickly become saturated [14].

All this takes a lot of energy, and it is not always possible.

What’s more, we do not all have the same ability to convert folic acid… 

In particular, mutations can reduce the activity of an enzyme called MTHFR. This enzyme is involved in the metabolism of methylated folate (5-mthf). In the general population, 60 to 70% of people have at least one of the two gene variants. This can therefore prevent or reduce the conversion of folic acid into its active form [15]. 

You can have your MTHFR enzyme function checked. To do so, ask your doctor to assess your MTHFR genetic polymorphism with a laboratory test.

Choosing a vitamin B9 supplement 

Whether or not you carry this mutation, the simplest option is to choose an active form of vitamin B9, one that is already methylated. It’s a shortcut and a welcome help for your body!

The "methylfolate" form is more effective at improving methylated folate (5-mthf) status [16] and is also more likely to be transferred to the foetus than folic acid [17]! 

If you want to make sure you get enough vitamin B9, look for the 5-methyltetrahydrofolate form on labels. Supplements made with lemon or spinach extracts also contain the active form. 

Our pregnancy snack Vanifique contains methylated folate (5-mthf) from spinach extract.

Folates Mama,’ the alternative to folic acid, with methylated, patented vitamin B9 Quatrefolic®

Our range of pregnancy food supplement (Baby Bump, Bump Essentials and Bump Powder) contain 5-methyltetrahydrofolate (Quatrefolic®), the patented form that can be absorbed directly. 

Folic acid and pregnancy are inseparable. Folic acid is a key element in the healthy development of the foetus and the health of the pregnant woman. Its role in the formation of the baby's nervous system and its ability to prevent congenital malformations make it an essential nutrient from the very first days of pregnancy.

A balanced diet combined with a suitable supplement helps to provide sufficient vitamin B9 and thus prevent complications related to a deficiency. For a worry-free pregnancy, it is therefore recommended to take a proactive approach to vitamin B9 supplementation, ideally starting before pregnancy. Furthermore, when trying for a baby, consuming it will be beneficial for fertility. 

Furthermore, folate metabolism requires other vitamins and minerals to function properly, such as vitamin B12 and choline supplement. Choosing pregnancy vitamins containing these nutrients is therefore a good option. Our supplement choline pregnancy also helps to meet your needs. 

During breastfeeding, requirements are also high. It is recommended to continue taking folates during breastfeeding, via a post partum food supplement for example.