Folate for Pregnancy: Methylfolate Benefits

OBGYN Dr. Kenosha Gleaton explains how folate supplementation can be beneficial for fertility, fertility treatment outcomes, and pregnancy.

By OBGYN Dr. Kenosha Gleaton

Folate, also known as vitamin B9, is an essential vitamin that comes in different forms, including methyl folate, with important implications relating to pregnancy and pregnancy loss. However, a less commonly known fact is that folate also plays a key role in fertility and the health of newborns and infants. A folate deficiency while pregnant could lead to a possible birth defect. While the body can't produce it, its intake can be increased through folate rich foods or a methylfolate supplement.

What Is Methylfolate? 

Methylfolate is the form of folate that is active in the body for use. This methylated form of folate is what is required for the body to benefit from folate. Unfortunately, up to 60% of the population carry a gene mutation known as the MTHFR mutation, that does not allow for proper conversion of folic acid to this active folate form of methylfolate. This gene mutation impacts the body's ability to utilize folate, which can lead to deficiencies. In this case, methylfolate supplements can be beneficial in getting the folate intake needed.

Folate Deficiency During Pregnancy

Due to the high frequency of the MTHFR gene mutation, many women are folate deficient with levels less than recommended. Folate deficiency can also develop as a result of a diet that's low in folate rich foods including dark green vegetables, citrus juices and foods.

In addition, folate deficiency can be difficult to detect because symptoms are usually nonspecific, but include mouth sores, tongue swelling, fatigue, and gray hair.

Folate Deficiency Symptoms

There are certain circumstances that warrant increased amounts of folate including a history of miscarriages, history of a child with a neural tube defect, and those taking antiseizure medications. Ask your OBGYN provider if additional folate supplementation is right for you. 

Women who have had a child with an NTD should take four milligrams (mg) of folic acid each day as a separate supplement at least three months before pregnancy and for the first three months of pregnancy. You and your OBGYN or other obstetric care provider can discuss whether you need a folic acid supplement with more than 400 micrograms daily.

Folate for Pregnancy and Fertility 

Folate in Prenatal Vitamins

When selecting a prenatal vitamin, it's necessary to select one that contains the right kind and the right amount of folate. Natalist Prenatal Daily Packets are made with 5-MTHF, the naturally occurring, predominant form of folate found in the body. Folate is recommended by the CDC and ACOG for all women of childbearing age to reduce the risk of spina bifida and other neural tube defects. ACOG specifically recommends that pregnant women get 600 micrograms of folic acid each day. [1] Because it’s hard to get this much folic acid from food alone, women should take a daily prenatal vitamin with at least 400 micrograms starting at least one month before pregnancy and continue during pregnancy for at least the first 12 weeks. 

Does Folate Help With Fertility?

In addition to prevention of birth defects and pregnancy loss, a daily multivitamin that contains folate before and during pregnancy may not only prevent birth defects, but also improve the chance of achieving and maintaining a pregnancy. [2] 

Does Folate Help With IVF?

If a woman is undergoing IVF, I recommend that she take over 800 mcg of supplemental folate. This is based off of a study suggesting a relationship between supplementation of certain micronutrients and higher chance of IVF success. [3] One of these micronutrients is folic acid (folate) and taking in at least 833 mcg appears to offer some benefit. In addition, there is evidence demonstrating that high folate supplementation (> 800ug) might protect against the adverse reproductive consequences of traffic-related air pollution. [3] 

Can You Take Too Much Folate?

While folate offers many benefits, there can be risks of consuming too much. According to the National Institutes of Health (NIH), the daily upper limit for folate from supplements and fortified food and beverages for adults 19 years and older is 1,000 mcg. [4] Excessive folate supplementation can cause neural development issues in children, cognitive decline in adults, and can cause recurrence of cancer in those with a personal history of cancer.

A Summary of Folate Health Benefits

Folate is a B vitamin that has many benefits for both mom and baby including improved fertility outcomes, decreased miscarriage rates, and reduction of birth defects (mainly neural tube defects). All forms of folic acid are not readily absorbed or utilized by the body, so it's important to seek out highly bioavailable methylfolate supplements. For quality vitamins and supplements, check out Natalist product offerings. 

References:

1. Nutrition During Pregnancy. FAQ001. ACOG. URL. Accessed July 2023. 
2. Chiu YH, Chavarro JE, Souter I. Diet and female fertility: doctor, what should I eat?. Fertil Steril. 2018;110(4):560-569. doi:10.1016/j.fertnstert.2018.05.027
3. Gaskins AJ, Mínguez-Alarcón L, Fong KC, et al. Supplemental Folate and the Relationship Between Traffic-Related Air Pollution and Livebirth Among Women Undergoing Assisted Reproduction. Am J Epidemiol. 2019;188(9):1595-1604. doi:10.1093/aje/kwz151
4. Folate Consumer Fact Sheet. NIH. November 2022. URL.