Folate and folic acid in pregnancy: how much, and which form

Folate, folic acid and methylfolate

These are three names for the same vitamin. Folate is the natural form in foods like leafy greens and pulses. Folic acid is the synthetic form used in supplements and fortified flour, and it is the form used in the research. Methylfolate, or 5-MTHF, is the already-active form your body would otherwise convert folic acid into. For general health, any of them works. In pregnancy the difference matters, because the recommendation is specific about both the form and the amount.

How much, and for how long

The NHS advice is 400 micrograms of folic acid a day, from before you conceive until the end of week 12. The recognised benefit comes at that intake, taken from at least one month before conception through the first trimester: folic acid raises maternal folate status, and low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus. The baby's neural tube forms in the first few weeks, often before a pregnancy is confirmed, so the ideal is to start when you begin trying. If your pregnancy was not planned, start as soon as you find out.

Who needs the higher 5 mg dose

Some women are advised to take a much higher dose, 5 milligrams a day, which is a prescription rather than an off-the-shelf product. This is for higher-risk pregnancies: a previous pregnancy affected by a neural tube defect, diabetes, a high BMI, certain medicines, or conditions like sickle cell. That higher dose is decided by your GP or midwife. If any of that might apply to you, ask them.

Methylfolate: what it is, and how to think about it

You will see prenatals, ours included, that use methylfolate rather than folic acid. Methylfolate is the active form, so there is no conversion step, and some women prefer it, especially if they have heard about the MTHFR gene. Methylfolate is a legitimate source of folate. For neural tube defects, though, the studied form is folic acid: the evidence base was built on it. So the NHS recommendation is a 400 microgram folic acid supplement, whichever form your prenatal uses. Your midwife can confirm your plan.

What our prenatal uses

Our prenatal provides folate as L-5-methylfolate, the active form, at 800 micrograms, alongside iron, iodine and vitamin D. To follow the NHS advice, pair a simple 400 microgram folic acid with the rest of your routine.