Vitamin B9 is one of the most essential vitamins during pregnancy. Folate and folic acid are forms of vitamin B9. While many people think they are similar and often use these terms interchangeably, they are very different. In this article, you will learn everything related to these two forms of vitamin B9 during pregnancy. Learn which one is best for pregnancy, the recommended intake, and what natural sources of folate to include in your everyday life.
Folate is the natural form of vitamin B9. You can find folate in natural food sources like leafy greens or legumes. On the other hand, folic acid is the synthetic form of vitamin B9, often found in supplements and fortified foods (1). Since folic acid has a very similar structure to folate, they are often considered the same (even if they are not).
Vitamin B9 has different functions in the body. Some of the most common benefits in the body of folate (2):
If you don't get the right amount of folate in your body, it could lead to a nutritional deficiency. The right amount of folate in the body is essential for both the mother and the baby.
Many factors could potentially lead to a deficiency: insufficient food intake, malabsorption (alcoholism or chronic gastric problems like Chron's disease), a more significant need like in pregnancy, or certain medications (2).
A nutritional deficiency could lead to birth defects like neural tube defects (the most common is spina bifida) or congenital heart disease for the baby. The results were promising in a study done where women were supplemented with folic acid. With the supplementation, there was a reduction of 90% of neural tube defects (3).
It doesn't take long for a nutritional deficiency to appear. It can be shown in just a few weeks of not consuming the right amount of folate for the mother. One of the consequences of lacking vitamin B9 is that it can potentially lead to anemia (4). Anemia es when you don't have enough red blood cells to carry the oxygen and nutrients to your body.
Additionally, folate is responsible for breaking down homocysteine. Folate, along with vitamin B6 and vitamin B12, oversees this amino acid's breakdown. Studies have shown that higher levels of homocysteine in the body could increase the risk of heart disease (5).
So, which one is better for pregnancy? Is folate better than folic acid? Both are essential when it comes to pregnancy.
For women who are not pregnant, it is best to get vitamin B9 through natural sources. This prevents having too much vitamin B9 in your system.
On the other hand, when it comes to pregnant women or women thinking about getting pregnant, it is better to supplement to ensure that you are consuming the correct dosage during the day.
When talking about supplementation, there are two forms that you can have: folic acid or 5-Methyltetrahydrofolate (5-MTHF). It seems that 5-MTHF is an active form of folate that could be more beneficial than folic acid (6) since it doesn't need to be activated like with folic acid (7). Thus, whenever possible, choose 5-MTHF over folic acid.
Although a deficiency is the most common problem, there are also concerns about having too much folate in your system. This typically happens when it comes from supplements.
Not all the folic acid you consume gets turned into the active form your body needs (5-MTHF). This process is slow and somewhat inefficient. Hence, you can have unmetabolized levels of folic acid in your blood, even the next day when it is time for you to get your next dosage (8).
High levels of unmetabolized folic acids have been linked to an increased risk of cancer (9) and the possibility of masking the deficiency of B12 anemia (10).
Now, this doesn't mean that you shouldn't supplement. Pregnant women should supplement to ensure they are getting enough vitamin B9 during the day. Just get the right supplement (hopefully 5-MTHF) and not more than the recommended intake.
For adults, the recommended daily intake is 400 mcg. On the other hand, pregnant women and those in lactation should consume 600 mcg.
It is essential for those planning on getting pregnant to have 600 mcg of folate at least one month before conception.
Although several foods are fortified with vitamin B9, there are natural sources of folate food. Try to have at least 200 mcg of folate from the diet and along with the supplement you are taking. Here is a list of the foods with the highest amount of folate and their serving sizes.
Remember that variety is key to a healthy diet. Include several of the foods above, but make sure to add other foods since a pregnant woman needs folate and other essential vitamins and minerals.
Like we always like to say: always eat the rainbow. Each different color of veggie and fruit has certain nutrients. Thus, make sure to add lots of color during your day.
1. Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-8. doi: 10.3109/00498254.2013.845705. Epub 2014 Feb 4. PMID: 24494987.
2. Ebara S. Nutritional role of folate. Congenit Anom (Kyoto). 2017 Sep;57(5):138-141. doi: 10.1111/cga.12233. Epub 2017 Jul 25. PMID: 28603928.
3. Czeizel AE, Dudás I, Vereczkey A, Bánhidy F. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients. 2013 Nov 21;5(11):4760-75. doi: 10.3390/nu5114760. PMID: 24284617; PMCID: PMC3847759.
4. Green R, Miller JW. Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status. Semin Hematol. 1999 Jan;36(1):47-64. PMID: 9930568.
5. Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J. 2015 Jan 10;14:6. doi: 10.1186/1475-2891 14-6. PMID: 25577237; PMCID: PMC4326479.
6. Amanda M Henderson, Rika E Aleliunas, Su Peng Loh, Geok Lin Khor, Sarah Harvey-Leeson, Melissa B Glier, David D Kitts, Tim J Green, Angela M Devlin, L-5-Methyltetrahydrofolate Supplementation Increases Blood Folate Concentrations to a Greater Extent than Folic Acid Supplementation in Malaysian Women, The Journal of Nutrition, Volume 148, Issue 6, June 2018, Pages 885–890,
7. Cochrane, K.M., Mayer, C., Devlin, A.M. et al. Is natural (6S)-5-methyltetrahydrofolic acid as effective as synthetic folic acid in increasing serum and red blood cell folate concentrations during pregnancy? A proof-of-concept pilot study. Trials 21, 380 (2020). https://doi.org/10.1186/s13063-020-04320-3
8. Obeid R, Kirsch SH, Dilmann S, Klein C, Eckert R, Geisel J, Herrmann W. Folic acid causes higher prevalence of detectable unmetabolized folic acid in serum than B-complex: a randomized trial. Eur J Nutr. 2016 Apr;55(3):1021-8. doi: 10.1007/s00394-015-0916-z. Epub 2015 May 6. PMID: 25943647.
9. Rees JR, Morris CB, Peacock JL, Ueland PM, Barry EL, McKeown-Eyssen GE, Figueiredo JC, Snover DC, Baron JA. Unmetabolized Folic Acid, Tetrahydrofolate, and Colorectal Adenoma Risk. Cancer Prev Res (Phila). 2017 Aug;10(8):451-458. doi: 10.1158/1940-6207.CAPR-16-0278. Epub 2017 Jun 9. PMID: 28600398; PMCID: PMC5544920.
10. Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr. 2007 Jan;85(1):193-200. doi: 10.1093/ajcn/85.1.193. PMID: 17209196; PMCID: PMC1828842.
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