Folic Acid – A necessary vitamin for pregnancy

Folic Acid – A necessary vitamin for pregnancy

Vitamin B9 belongs to the group B vitamins and it is also called folic acid or folate. However, are these compounds the same? If not, which one is better?

All the cells from the human body need folic acid or vitamin to develop and regenerate the DNA (deoxyribonucleic acid). Without being able to generate DNA, the body cannot produce new cells to heal wounds.

When the DNA cells are damaged and cannot be repaired, the body becomes vulnerable and susceptible to diseases. Folic acid is basic for the proper functioning of the organism and our health.

Some of the additional benefits of folic acid are: preventing problems during the pregnancy, lowering the risk of suffering a stroke and reducing high homocysteine levels.

Let’s start talking about what is vitamin B9 or folic acid, its main functions and sources.

What is Vitamin B9 (folic acid) and what is it for?

Vitamin B9 is a water soluble substances that belongs to the B vitamin group, which is necessary for key metabolic processes.

Vitamin B9

Main functions

  • Producing genetic material (DNA, RNA)
  • Participating in the synthesis of amino acids involved in cell growth (which is why they are so important for the growth of the fetus)
  • Producing red cells
  • Reducing the blood homocysteine levels
  • Supporting the adrenal function and immune system
  • Calming and keeping the nervous system healthy

Foods rich in folic acid

Sources of Vitamin B9

The best sources of vitamin B9 are liver, yeast (cereals), asparagus, green leaf vegetables (chard, broccoli…), legumes (chickpeas, beans, peanuts…), beef liver, egg yolk, wheat germ, some processed products that have been enriched with this vitamin (cereals or biscuits). Nutrition is the key to include this vitamin in our organism.

Find out the best sources of vitamin B9 to include them in your nutrition. Click here

Deficiency of folic acid or vitamin B9

Some of the symptoms are weakness, irritability or a lack of appetite. When the deficiency is severe, it can result in a rare disease known as megaloblastic anemia. This is due a defect in the DNA synthesis, the red cells end up being bigger than usual, affecting the tissue oxygenation.

Vitamin B9 deficiency

This is specially relevant for women who want to become pregnant, since a deficiency can produce malformations in the fetus.

Benefits of folic acid for health

This vitamin is advised in the following cases:

  • Before and during pregnancy in order to avoid problems in the formation of the neural tube
  • When we suffer anemia due to a deficiency
  • If we suffer a deficiency of this vitamin due to medication
  • In cases of folate absorption disorders in the bowel (bad absorption syndrome, alcohol abuse, inflammatory bowel disease)
  • Also for cardiovascular diseases
  • When there is risk of thrombosis, stoke and heart attack
  • For brain dysfunction (memory loss, dementia, depression, Alzheimer)
  • To improve the wound healing
  • When there is a risk of infection
  • To prevent cell degeneration

Recommended dose

The recommended dose of this vitamin varies depending on personal circumstances. For example, the recommended dose for a pregnant woman who wants to prevent possible neural defects is 400mcg (micrograms). On the other hand, those who want to lower their blood homocysteine levels should take 0.8-1 mg/day (milligrams daily). We have already seen some of the food sources of this vitamin.

Why does a folate deficiency happen?

The natural sources of folate can become unstable and oxidize (losing their vitamin value) as a result of the manufacturing process. Therefore, its bioavailability tends to be between a 25-50%, depending on the food. The storage and cooking method can also reduce the folate content.

Obviously, the behavior and habits of people will condition the folate availability. Moreover, there are other factors that also contribute to triggering this vitamin deficiency such as: medicines, cigarettes, alcohol, eating disorders, a lack of vegetables in the diet or a strict diet for a long period of time.

Folate Supplements

Human beings need a constant supply of folate (vitamin) because they are not capable of synthesizing it and their deposits are limited

The real amount of folate in food can be lower than what appears on the nutrient facts. That is why many people will recur to natural folic acid supplementation. More specifically, it will benefit those who are not getting the necessary supply from their diet.

What is the active form of Vitamin B9?

In order to absorb vitamin B9, our body needs to metabolize its active form, called 5-Methyltetrahydrofolate or 5-MTHF.

Chemical structure of Vitamin B9

This process is regulated by an active coenzyme known as Methyltetrahydrofolate reductase (MTHFR). This process takes place in several stages or phases.

Some people produce inadequate levels of said enzyme due to a genetic condition: MTHFR Gene Mutation interfering in these conversion phases.

Are folic acid and folate the same thing?

Many people, even health professionals argue that they are basically the same nutrient. While folic acid is often seen as a supplementary form of folate or vitamin, there is an important difference between these two compounds.

Using both terms is quite common when we want to refer to vitamin B9. However, the truth is that they are two different substances

Folate is the term use to name vitamin B9 (bioavailable form) which is naturally present in food. Folic acid refers to the oxidized synthetic compound used in dietary supplements (prenatal…) and to produce (enrich) some products.

What is the MTHFR gene mutation?

As we have previously seen MTHFR refers to an enzyme that allows us to obtain the active form of vitamin B9. It also transforms homocysteine in methionine, contributing to the proper metabolism and creation of glutathione.

The genetic mutation means that said enzyme loses part of its activity. Consequently, this will affect the associated physiological processes, inhibiting our ability to methylate (eliminate toxins), and transform the folic acid from food into the metabolite we need, L-5-Methyltetrahydrofolate

Those who have a defective MTHFR gen will have problems when it comes to processing folic acid. In fact, they can even experience an accumulation of this vitamin in the body and, therefore, a risk of toxicity.

It also includes other substances like heavy metals.

MTHFR mutation

Around a 30-50% of the population has a MTHFR gene mutation. Between a 14-20% of them have a severe mutation that drastically affects their health, to the point that its conversion into folate is practically impossible

Folic acid will accumulate in the body if it is not transformed into its usable form. Therefore, this can increase the homocysteine levels, which is associated with a higher risk of cardiovascular disease. This also affects the conversion to glutathione, a powerful antioxidant that the body needs to get rid of waste substances.

What is the Difference between Folic Acid and Folate?

Folate is commonly known as “folic acid” and both are regarded as interchangeable terms. However, there are important differences between the natural and synthetic forms of folate.

Folate is a generic term for this water soluble vitamin, which works in one-carbon transfer reactions and which is present in several chemical forms.

Folic acid, the folate form used to enriched foods and most supplements, is a synthetic form: pteroylmonoglutamate.

Chemical structures

Moreover, we can also find the forms folinic acid and l-methylfolate as food supplements.

Folic acid excess

Those who do not process this element properly due to a gene mutation can accumulate it. Then, it is known as “non-metabolized folic acid”. One of the things we should bear in mind is that, said excess can lead to “unmasking” a possible vitamin B12 deficiency.

L-methylfolate supplements

The benefit of taking supplements to reduce the neural tube is undeniable and folate plays a vital role in our health.

However, the potential risks associated with synthetic folic acid make other folate forms a much better choice. For example, l-methylfolate which can be directly absorbed by the body:

  • Most bioavailable form (even better than foods)
  • Avoiding the MTHFR mutation and inefficiency of the enzymatic conversion
  • Unmasking the vitamin B12 deficiency
  • Preventing interactions with medication that could reduce the enzyme activity
Those who have a MTHFR mutation should not take any source of folic acid since it can be very toxic. The only form that we could consider taking is L-MTHF, which is the methyl form the body is going to use.


Side effects of l-methylfolate

However, natural folate can also trigger some changes in the mood and other problems like: irritability, insomnia, muscle and joint pain, anxiety, palpitations, nausea, headaches, migraines…

A way of palliating said symptoms is combining a folate supplement with a source of niacin.

Folic acid for pregnancy

Taking this vitamin during pregnancy can prevent serious and common defects on the fetus, like spina bifida and anencephaly. If the pregnant woman knew this, she would take folic acid and many children who are born with these problems would be healthy.

It is a very useful vitamin throughout our whole lives, from pregnancy to adulthood.

Folic acid for pregnancy

A pregnant woman needs more folic acid: it is involved in the growth of the placenta and fetus, helps to prevent several types of malformation, specially of the brain and backbone.

Folic acid plays a role in the cell processes during the growth of the fetus, which is why it prevents neural tube malformations. This issue happens in one out of 1000 births. That is why we think that this defects are common and very serious. To put it simply, they occur when the neural tube, which is made up by the brain and backbone, are not properly closed. Folic acid supports the proper fusion of the neural tube. “The spinal closure will be complete if we take the product” according to Dr. Donald R. Mattison, ex medical director of March of Dimes Births Defects Foundation.

The neural tube problems include anencephaly and spina bifida.

  • Anencephaly occurs when part of the brain of the baby is not completely formed. This disease is incompatible with life.
  • Spina bifida is what happens when the fetus is not completely close. This type of disease affects thousands of babies every year.

Spina bifida

According to The March of Dimes, if women took enough folic acid before and during pregnancy, the risk of this type of defects would drop in a 70%.

Other studies suggest that it could prevent a 50% of the defects in general, including cleft lip and cleft palate.

If you are thinking about having a baby, it is advisable to start taking folic acid previously. This is mainly due to the fact that the neural tube is developed during the first weeks of the pregnancy. However, half of the pregnancies are not planned, which is why all fertile women should take 400mcg daily. Other good sources of this vitamin are spinach, broccoli, asparagus, orange juice, wheat germ and enriched grains (pasta, rice, cereals…).

Folic acid and fertility

It can increase the female fertility. In fact, there was a clinical study in 2006 conducted on 18500 pregnant women that lasted eight years.

Those women who took a folic acid multivitamin for six days a week had a 40% more chances of becoming pregnant than those who did not take supplementation.

In a study from 2014, published in the “Biomedicina Reproductiva online” journal, it was proven that giving this vitamin to women with fertility problems increased the success of an in vitro fertilization (IVF).

To sum up, the research proves that its supplementation increases the fertility in women and the success of in vitro fertilization.

Folic acid and cardiovascular health

It has been proven that it can reduce the blood homocysteine levels. Homocysteine is a molecule with a structure that is similar to that of cystine, an amino acid that can be found in enzymes and proteins.

High blood homocysteine levels are associated with atherosclerosis (hardening and narrowing of the arteries). Moreover, it also involves a higher risk of suffering heart attacks, strokes, blood clots, etc.

Folic acid can reduce the onset of cardiovascular diseases by controlling the blood homocysteine levels.

The clinical research has proven that we can slightly reduce the blood homocysteine levels between a 20% and 30%. All this thanks to folic acid dietary supplements.

Cardiovascular Health


Folic acid and strokes

Some of its benefits include protection against heart attacks and strokes.

In a clinical study published by the Journal of the American Medical Association, more than 20000 adults from China who had high blood pressure participated in the study.

  • Unlike what happens in the United States and Europe, Chinese products are not enriched with folic acid.
  • The participants made two groups: one took a folic acid tablet and a medicine for high blood pressure. Meanwhile, the other group took a pill that only had an active ingredient for hypertension.
  • The treatment lasted 4.5 years on average.
  • The study showed how only a 2.7% of those who took folic acid and the hypertension medicine suffered a stroke. On the other hand, a 3.4% of those who did not take it suffered a stroke.

Therefore, the study proves how taking folic acid with medicine for hypertension lowers the risk of suffering a stroke.

Folic acid, more properties

This versatile vitamin B helps to keep proper homocysteine levels: an amino acid that can damage the blood vessels, increasing the risk of suffering cardiovascular diseases.

Folic acid is fundamental to produce energy and keep the body healthy. It is indispensable to create new cells and for fertile women, as we mentioned previously. Several studies have proven that it keeps the skin healthy along with vitamin B12 and B6.

This vitamin tends to be included in multivitamins, providing a great variety of beneficial amino acids for our health.

Which Supplement should Pregnant Women Take: folic acid or 5-MTHF?

According to the scientific evidence, folic acid prevents those problems that the fetus may suffer. Therefore, there is no reason why we should not take it or, at least, we still need more studies with other supplements.

There is some uncertainty regarding the effectiveness of 5-MTHF in pregnant women, since it is difficult to prove. No mother would undergo this experiment, knowing that folic acid works

Folic acid and growth

What do the experts think about folic acid?

A lack of knowledge about folic acid

In a recent report, the health organizations have warned that approximately a 90% of the population suffers a folate deficiency. This percentage rises to 99% in women.

The fact that women suffer this folic acid deficiency (vitamins), is even more dangerous if we take into account that it can directly impact newborns.

Many experts have already stated: “if we could fix the folate deficiency before the pregnancy, a 70% of the fetus malformations could be avoided”.

Folic acid rejuvenates the brain

A study from several European universities has revealed that taking vitamins of this kind (folic acid) preserves our mental capacities even at an old age. This vitamin fights against cognitive aging.

The researchers discovered that doubling the recommended dose of folic acid improves the memory in the Annual Congress of the Alzheimer Association in Washington. The study was conducted on 800 people between the ages of 50 and 75. They took either 800mg of folic acid or a placebo for around three years. The intelligence test performed afterwards proved that those who took the vitamin had a better memory. In fact, they were 5.5 years younger regarding the placebo group.

Increasing the folic acid intake is good for the heart and brain

The specialists warn that we are not using all the possibilities from nutritional medicine to prevent diseases. Actually, nutritionists suggest taking vitamin dietary supplements not only due to the fact that folic acid can prevent neural tube defects during pregnancy. Rather, it can also significantly lower the risk of cardiovascular diseases.


  1. Summary of Folic Acid
  2. Natural Folate vs Synthetic Folic Acid
  3. Mesiano S, Jones EE. Fertilization, pregnancy, and lactation. In: Boron WF, Boulpaep EL, eds. Medical Physiology. 3rd ed. Philadelphia, PA: Elsevier; 2017:chap 56.
  4. Institute of Medicine (US) Standing Committee on the Scientific. Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Washington (DC): National Academies Press (US); 1998. ISBN-10: 0-309-06411-2ISBN-13: 978-0-309-06411-8
  5. Cortese C, Motti C. MTHFR gene polymorphism, homocysteine and cardiovascular disease. Public Health Nutr. 2001 Apr;4(2B):493-7.
  6. Venn BJ, Green TJ, Moser R, Mann JI. Comparison of the effect of low-dose supplementation with L-5-methyltetrahydrofolate or folic acid on plasma homocysteine: a randomized placebo-controlled study. Am J Clin Nutr. 2003 Mar;77(3):658-62.
  7. Folate – Oregon State University
  8. The Little Known (But Crucial) Difference Between Folate and Folic Acid
  9. Quatre Folic
  10. MTHFR Mutation

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About Javier Colomer
Javier Colomer
"Knowledge Makes Stronger", Javier Colomer's motto, sets out his clearest statement of intentions expressing his knowledge and fitness experience.
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