Vitamin B9

Doctors recommend systematic supplementation with vitamin B9 at 400 µg per day, for at least 4 weeks before conception and up to 8 weeks after. It is truly the essential vitamin for a baby project and throughout pregnancy. If there is only one supplement to take, this is the one. 

This is because the demand for vitamin B9 increases very rapidly in early pregnancy, notably as it is involved in the processes enabling the correct closure of the baby's neural tube, which occurs in the first weeks of pregnancy. 

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

It is very likely that you are deficient in vitamin B9. According to the SU.VI.MAX study, three quarters of women have intakes below the recommended levels. 

A folate deficiency occurs when the concentration of folates in red blood cells falls below 100 µg/L. A moderate deficiency is indicated when folate levels are between 100 and 200 µg/L.

Vitamin B9 is very sensitive in food — processing, storage, cooking and other factors all contribute to reducing the vitamin B9 content of foods. Dietary folates, found in their natural state, can be lost by up to 30% during food processing, depending on the type of cooking used. Furthermore, it is not present 100% in its active form in food, so the body must convert it. 

Vitamin B9 deficiency can be due to malabsorption disorders (coeliac disease, inflammatory bowel disease, etc.), or to the intake of toxic substances, such as alcohol, which interferes with the absorption and assimilation of folates. A mutation in the MTHFR gene involved in folate metabolism can also be the cause of a deficiency. 

Folate deficiency is rarely isolated — it can be associated with vitamin B12 deficiency in particular, as these two vitamins are closely linked in metabolism. 

Vitamin B9 supplementation should always use the methylated form, i.e. (6S)-5-methyltetrahydrofolic acid (or 5-MTHF). This is the form that is best absorbed by the body, as it is directly active and readily assimilated by the organism. Moreover, whether or not you carry a mutation of the MTHFR gene (the gene responsible for converting folates into their active form), this form will be absorbed by the body — unlike folic acid, which will not be assimilated. 

In dietary supplements, this form can be found under several names: 

The patented form Quatrefolic® (present in our range of pregnancy dietary supplement, menopause dietary supplement, etc).

Derived from a lemon extract (present in our pregnancy gummies).

Derived from a spinach extract (present in our pregnancy snack). 

The pregnancy vitamins containing folates exist mainly in two forms: folic acid and 5-MTHF (the active methylated form).

Folic acid, the synthetic form of folate, is oxidised and absent from natural foods. It has no immediate biological action and must be converted by the body before it can be used. However, this conversion process can be slow and incomplete, particularly when taken in large amounts, leaving unconverted folic acid in the body.

5-MTHF, on the other hand, is more bioavailable and directly active in the body without requiring this conversion. Studies show it is more effective than folic acid at raising folate levels in the blood and red blood cells, and is also more readily transmitted to the foetus. 5-MTHF also helps reduce homocysteine, a compound that, in excessive amounts, can increase the risk of neural tube defects in the baby.

The conversion of folic acid into its active form is slow and saturable. This extremely low conversion rate means that when folic acid is present in large quantities, not all of it will be converted and free folic acid will remain in the body. Furthermore, more than half of us carry a mutation in the MTHFR gene that prevents the conversion of folic acid into its active form. 

Certain medications, such as methotrexate and trimethoprim, block the conversion of folic acid into its active form by inhibiting the DHFR enzyme. In these cases, 5-MTHF is a better option as it bypasses this step and ensures a supply of active folates, even when the enzymatic pathway is disrupted.

At the cellular level, methylation is simply the addition of a tiny molecule called a methyl group (CH3) to another molecule. This has the effect of activating the receiving molecule. Once activated, the molecule can then carry out its role, which is to ensure the proper functioning of our body's systems.

The MTHFR gene is responsible for producing the enzyme methylenetetrahydrofolate reductase (MTHFR), an enzyme that enables the methylation of folates into their active form, 5-methyltetrahydrofolate (5-MTHF). 

Everyone has two MTHFR genes, one inherited from their mother and one from their father. Some people inherit a variant or mutation of the gene that produces an MTHFR enzyme with impaired function. 

Depending on the population studied, between 30–40% and 60–70% of people carry at least one mutated gene.

55% of the European population carries at least one of the 2 mutations. 

These mutations affect the activity of the enzyme, making it less efficient at converting folates into their active form. 

If the MTHFR enzyme is sub-optimal, it means you have fewer activated folates in your body and a higher homocysteine level. This increases folate requirements and contributes to the risk of several conditions linked to folate status, such as neural tube defects in the baby and cardiovascular disease.