Folate vs. Folic Acid for a Healthy Pregnancy


Folate, or vitamin B9, is a broad term encompassing various nutrient forms, including folic acid, methylfolate, and folinic acid.
Conventional folic acid has been impactful due to public health initiatives, however, concern has risen about its bioavailability.
Forms we see naturally occurring in food can be better options for those trying to conceive, pregnant, and postpartum.
Folate vs. Folic Acid for a Healthy Pregnancy

Choosing a prenatal multivitamin is one of the most important things you’ll do for the health of your pregnancy. A nutrient you’ve likely heard about is folate or folic acid - and for good reason! Folate, or vitamin B9, is a broad term encompassing various nutrient forms, including folic acid, methylfolate, and folinic acid. This prenatal essential plays a vital role in red blood cell production, amino acid processing, and DNA building, with its significance magnifying during pregnancy as it influences healthy neural tube development, shapes the baby's brain, and forms the spinal cord.

The Bioavailability Factor

Bioavailability, measuring how effectively the body absorbs a substance, is crucial, especially during pregnancy. After all, we want to absorb and utilize the nutrients we consume! Although conventional folic acid has been impactful due to late '90s public health initiatives, concerns arise about its bioavailability over the forms we see naturally occurring in food. 

Folic Acid Controversy

Understanding the controversy between methyl-folate and folic acid requires revisiting the late 1990s public health campaign promoting folic acid fortification. Despite its success in reducing neural tube defects, folic acid poses challenges due to its lower bioavailability and potential for unmetabolized by-products. That means you run the risk of not getting enough folate to meet your body’s needs, as well as risks associated with “Unmetabolized folate” or UMFA. The impact of UMFA could vary among individuals based on their genetics and the quantity of folic acid obtained from fortified foods and supplements, potentially leading to adverse effects in some cases. In fact, a 2015 research paper published in the reputable American Journal of Clinical Nutrition looking at UMFA in umbilical cord blood of newborns noted that: 

“...Because of concerns over potential adverse health outcomes, the functional ramifications of the observed high concentrations of folate and UMFA in maternal fetal circulation in the current study warrant additional investigation. Specifically, the dose of folic acid in prenatal supplements should be reconsidered in light of our findings to provide the optimal health benefits to the growing fetus while avoiding undue risk.” (1)

It’s important to note that UMFA is only a concern with folic acid and not with methylfolate or folinic acid. 

Is Folate the Same as Folic Acid?

No! Even though the two names are used interchangeably, there are differences. Folic acid is a synthetic form introduced for purposes of mandatory fortification of the food supply in 1998. Natural folate, found in organ meats, leafy greens, citrus fruits, and legumes, differs in its conversion process in the body. Folic acid requires conversion to 5-MTHF for effective use, posing challenges for individuals with genetic variations.

Clinical-Backed Approach to Folate

Our commitment aligns with FDA, NIH, and scientific research—supporting adequate folate intake inclusively. Research increasingly supports higher levels of folate intake for overall reproductive health. We take pride in our robust folate levels in FullWell Prenatal and the forms they are in.

Folic Acid Use in Prenatal Multivitamins: A Critical Examination

Numerous prenatal multivitamins, including the top five best-selling brands in the United States, rely solely on folic acid, as indicated by sales data from 2019 and the trailing 12 months until April 2020. This raises a fundamental question: given the prevalence of genetic variation and the National Institutes of Health's endorsement of 5-MTHF as a potentially more advantageous alternative, why persist with folic acid?*

*Based on the leading US prenatal multivitamin brands by 2019 & trailing 12-month retail sales (through April '20)

Several factors contribute to the continued use of folic acid. First, it has a 25+ year history of use, stemming from mandatory grain fortification in the late 1990’s. Second, it is far less expensive than methyl folate or folinic acid, making it the most popular form of folate used in dietary supplements and the easiest to study form in pregnancy supplementation studies. 

But does this mean it is the best form of folate to use in dietary supplements? 

When comparing folic acid and methylated folate (5 MTHF) in pregnancy, it’s crucial to acknowledge them as separate variations of the same nutrient, folate. Both contribute to maintaining adequate folate levels, a crucial factor in supporting healthy neural tube development during pregnancy. The Food and Drug Administration (FDA), with substantial scientific concurrence from qualified health experts, asserts that sustaining sufficient folate intake can support normal neural tube development. Importantly, the FDA rejects the notion that folic acid is the exclusive folate form for minimizing neural tube defect incidences.

The FDA states that the connection between diet and disease is better explained when we take into consideration all the natural forms of folate, not just the synthetic form we know as folic acid. We support the FDA's perspective that encourages adequate folate intake to maintain sufficient levels, regardless of whether through folic acid or natural folate sources.* (2)

The Best Form for Pregnancy and Beyond

At FullWell, your health is our priority. We purposefully chose to use L-5-methyl-tetrahydrofolate calcium (methyl-folate) and calcium folinate (folinic acid) in our Women's Prenatal. These naturally occurring forms of folate, found in folate-rich foods, ensure maximum bioavailability, irrespective of genetics. Consult your healthcare professional to tailor your prenatal nutrition, and explore our Directory for qualified specialists.

Are you fascinated with this topic? Still have questions?
Dive even deeper into the research and biochemistry in this article by Lily Nichols, RDN, CDE. 
* The information on this website is provided for educational purposes only and should not be treated as medical advice. FullWell makes no guarantees regarding the information provided or how products may work for any individual. If you suffer from a health condition, you should consult your health care practitioner for medical advice before introducing any new products into your health care regimen. For more information, please read our terms and conditions.