Folate vs. Folic Acid: The Difference For Pregnancy

Let’s be clear about one thing: finding a prenatal multi with folate is really important during pregnancy. In addition to supporting neural tube development for babies, it’s essential for pregnant women, too—it’s a water-soluble vitamin known to be involved with DNA methylation (a process related to gene expression). It also supports red blood cell formation. All in all, folate is an essential nutrient that is important to look for in a prenatal multivitamin.*

Notice how we’re emphasizing folate rather than folic acid? That’s because folic acid is a form of folate—it ultimately gets converted in the body to become the active form of folate, 5-MTHF. But while folic acid supplements get a lot of buzz as a prenatal must-have, folic acid may not be the most ideal form of folate for people with a genetic variation (MTHFR gene) that can make it difficult to efficiently utilize. And that’s why we opted for the active form of folate as 5-MTHF while formulating our Essential Prenatal, Essential Postnatal and our other multivitamins.*

Is Folate the Same As Folic Acid?

The short answer is no! Folate and folic acid are both forms of essential vitamin B9 but, folic acid is a synthetic version of folate.

Folic Acid: Folic acid is not naturally found in nature or in our body. It was introduced to our diet through fortified foods in the mandatory folic acid fortification of grain products in 1998.

Folate: On the flip side, folate is naturally present in some foods so chances are you’re consuming natural folate on a daily basis—food sources of folate include leafy vegetables, citrus fruits, and legumes such as kidney beans and lentils.

So, what’s the difference between folate and folic acid?: It comes down to the way folic acid is converted in the body. Again, when we consume folic acid, it has to be converted to the active form of folate that our bodies can use—which is called 5-methyltetrahydrofolate, or 5-MTHF. And that’s where some people can run into a problem. Up to one-third of adults have a genetic variation that makes it difficult to efficiently utilize folic acid specifically—which means that in addition to the genetic issues surrounding folic acid, those with either excess intake of folic acid or the genetic variation may be prone to excess of unconverted folic acid in their bodies.*

This is one of the chief reasons why we opted for 5-MTHF, the active form of folate we include in our multivitamins, prenatal multivitamin and postnatal multivitamin—helping to bypass the folic acid-to-folate conversion. The National Institutes of Health (NIH), which is the steward of medical and behavioral research for the nation, calls 5-MTHF the “active form of folate” and reports that supplementation with 5-MTHF might be more beneficial than with folic acid for people with this genetic variation.* (2)

Why Is Folate (as 5-MTHF) So Important in Pregnancy?

Folic acid and methylated folate as 5-MTHF are different forms of the same nutrient (folate) that both help support adequate folate levels, a key nutrient for supporting neural tube development. The U.S. Food and Drug Administration (FDA) explains that healthful diets with adequate folate may reduce a woman's risk of having a child with a brain or spinal cord birth defect. As part of this, the FDA does not agree that folic acid is the only form of folate to help support neural tube development. (1) The American Pregnancy Association notes that since the neural tube develops within the first 28 days of pregnancy so it's recommended women of reproductive age consume folate.* (4)

The FDA further explains that “the relationship is more accurately described as being related to all of the biologically active vitamin forms of folate rather than just to the synthetic form of the vitamin (i.e., folic acid).” We agree with the FDA's comments. Bottom line? The utility of increased folate intake in support of maintaining adequate folate levels is what is of importance, whether achieved through folic acid or folate.* (1)

Finding a Prenatal With Folate, Not Folic Acid

Many prenatal multivitamins use folic acid. Which begs the question: if this genetic variation is prevalent, and the NIH suggests that 5-MTHF might be the more beneficial alternative for some pregnant women, why stick with folic acid?*

There are a few reasons—namely, that folic acid has a long history of use from mandatory fortification of grains to use in supplements for many years. Folic acid has been known as a shelf-stable and more cost-effective version of folate. (It’s been so popular for so long, chances are you know the term “folic acid” more than “folate.”) Because of this use history and popularity as an ingredient, many pregnancy supplementation studies have relied on data from folic acid—which means that many companies developing prenatal multivitamins stick to the popular choice.

What Are the Recommended Amounts of Folate?

In line with FDA, NIH, and other scientific research, our goal is simple: to support adequate levels of folate intake, while being as inclusive as possible and prioritize folate absorption. In other words, we just didn’t think it made sense to develop a prenatal multivitamin that relied solely on folic acid, which up to one-third of women might not be able to use efficiently. Further to this, we wanted to avoid excess of unconverted folic acid given the trending research in this area.*

The recommended amount for adults is 400 mcg DFE (Dietary Folate Equivalents) per day. But, how much folate for pregnancy is recommended? Well, pregnant women or women who are trying to conceive should aim for a 400 to 1,000 mcg DFE daily dose. Research shows it could take up to 3 months of supplementation to reach optimal folate levels to support pregnancy. (4) Both our Essential Prenatal and Essential Postnatal Multivitamin include 1,000 mcg DFE of folate for those trying, already pregnant or who just gave birth.*

What do the results of the clinical study on folate in Ritual’s Essential Prenatal Multivitamin show?

Before we dive in, let’s get into the context. As detailed, during pregnancy, the body’s need for folate increases to support the rapid cellular growth and development of the fetus. It is important to ensure an adequate folate status during pregnancy. Folate is available in supplements as folic acid, a synthetic form that the body must convert into its active form for use, or as methylated folate, which the body can use without conversion. When excess folic acid is consumed, it can remain unmetabolized in the blood as unmetabolized folic acid (UMFA).

Emerging research has prompted interest in understanding how unmetabolized folic acid (UMFA) levels in late pregnancy may relate to developmental and metabolic outcomes in children. Studies are beginning to explore potential associations between elevated UMFA and factors like embryonic growth patterns, neurodevelopment, immune health, and metabolism—underscoring the importance of further research into folate status in during pregnancy. (5-7)

This 24-week university-led randomized, double-blind, controlled clinical trial was conducted to compare the effect of Essential Prenatal, which contains 1,000 mcg DFE of methylated folate (6S-5-Methyltetrahydrofolate), to a leading prenatal multivitamin containing 1,330 mcg DFE of folic acid, on folate levels in the maternal blood, umbilical cord blood, and the placenta.

Key learnings

• In a 24-week clinical trial, Essential Prenatal, compared to a leading brand, resulted in 41x less unmetabolized folic acid in maternal plasma.†*
• Essential Prenatal is clinically proven to provide effective folate support while helping moms stay within safe intake levels.†* 29% of moms taking a leading prenatal exceeded the Tolerable Upper Intake Level (UL).
• Compared to another leading prenatal multivitamin with folic acid, our prenatal multivitamin demonstrated a more efficient utilization of folate.†*

Want to learn more about the clinical study on our Essential Prenatal? Dive into our key learnings.

†Based on a 24-week, randomized, double-blind, controlled clinical trial on 62 second and third trimester pregnant women.

References:

1. Food and Drug Association. Department of Health and Human Services. (1996). Food Labeling: Health Claims and Label Statements; Folate and Neural Tube... Federal Register, 61(44).

2. U.S. Department of Health and Human Services. (n.d.). Office of Dietary Supplements - Folate. NIH Office of Dietary Supplements.

3. Carboni, Lorena. “Active Folate versus Folic Acid: The Role of 5-MTHF (Methylfolate) in Human Health.” Integrative Medicine (Encinitas, Calif.), vol. 21, no. 3, 2022, pp. 36–41.

4. “Folate and Folic Acid in Pregnancy.” American Pregnancy Association, 10 Apr. 2021.

5. Plumptre L, Masih SP, Ly A, Aufreiter S, Sohn KJ, Croxford R, Lausman AY, Berger H, O'Connor DL, Kim YI. High concentrations of folate and unmetabolized folic acid in a cohort of pregnant Canadian women and umbilical cord blood. Am J Clin Nutr. 2015 Oct;102(4):848-57. doi: 10.3945/ajcn.115.110783. Epub 2015 Aug 12. PMID: 26269367.

6. Raghavan R, Selhub J, Paul L, Ji Y, Wang G, Hong X, Zuckerman B, Fallin MD, Wang X. A prospective birth cohort study on cord blood folate subtypes and risk of autism spectrum disorder. Am J Clin Nutr. 2020 Nov 11;112(5):1304-1317. doi: 10.1093/ajcn/nqaa208. PMID: 32844208; PMCID: PMC7657337.

7. Office of Dietary Supplements. Folate: Fact Sheet for Health Professionals. National Institutes of Health, Department of Health & Human Services, 2022.