Prenatal vitamins: folate vs. folic acid and understanding the MTHFR mutation

Why prioritizing prenatal vitamins matters for your pregnancy journey

You’re embarking on the journey towards motherhood, and undoubtedly, you’re seeking the best possible start for your baby’s health. In the whirlwind of information out there, it’s easy to feel overwhelmed. So, let’s clear the misinformation around prenatal vitamins together and take a closer look at their role in preventing neural tube defects (NTD).

Unraveling prenatal vitamins (PNV)

Prenatal vitamins aren’t your average multivitamin; they’re specially formulated to meet the unique nutritional demands of pregnancy. Recommended by reputable organizations like the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG), these powerhouse supplements provide elevated levels of vital nutrients such as folic acid, iron, and calcium.

For instance, while a regular multivitamin may contain around 400 mcg of folic acid, prenatal versions can provide up to 1000 mcg, highlighting their tailored support for expecting mothers.

Folic acid, a synthetic form of folate, emerges as a hero in prenatal nutrition. Its role in preventing neural tube defects (NTDs) in developing fetuses cannot be overstated. NTDs, encompassing severe conditions like spina bifida, anencephaly or cleft lip, underscore the critical need for adequate folic acid intake.

The SOGC and ACOG advocate for daily folic acid supplementation ranging from 0.4 to 1.0 mg, ideally commenced three months before conception. The first three months of an establish pregnancy is crucial as it coincides with the development of NTD. Even after this phase, continuing with prenatal vitamins throughout pregnancy and breastfeeding is recommended for sustained nutritional support.

Why folic acid steals the spotlight: a closer look at neural tube defects

It’s essential to grasp the nuances between folate and folic acid. Folate, occurring naturally in food, undergoes conversion to its active form, L-5-methylTHF through the action of the enzyme MTHF-reductase. On the other hand, folic acid, is a synthetic product which is more stable and makes it ideal for use in a supplement. 

But wait, what about 5-MTFH? Isn’t it touted as a viable alternative to folic acid? Here’s the scoop: while both play a role in folate metabolism, folic acid and NOT 5-MTFH takes the lead in preventing NTDs. 

While 5-MTFH is might confer some protection against NTD, it simply has not been studied as diligently as its synthetic form, folic acid. 

There are countless scientific studies showing a reduction in NTD across many different populations. The reduction in NTD with folic acid is so significant that in 1998, the United States began mandatory fortification of wheat flour with folic acid; several other countries including Canada, South Africa, Australia, and countries in South America followed suit. Food fortification has been linked to a 19% decrease in all NTDs, with an 11% decrease in anencephaly and a 23% reduction in spina bifida (study source: ACOG

It has been estimated that between 16% and 58% of NTDs could be prevented by folic acid supplementation. A recent case–control study reported that pre-pregnancy folic acid supplementation resulted in a 79% reduction in risk of spina bifida and a 57% reduction in risk of anencephaly.

Separating fact from fiction: the truth about folic acid and neural tube defects prevention

Here’s the bottom line: when it comes to reducing the risk of NTDs, folic acid reigns supreme. Despite the allure of alternatives like 5-MTFH, the evidence speaks for itself. Numerous studies have demonstrated the unparalleled efficacy of folic acid in preventing NTDs—a feat that cannot be replicated by 5MTFH

Navigating the evidence: why folic acid gets the green light

But don’t just take our word for it. Leading medical organizations—including the American College of Obstetricians and Gynecologists (ACOG) and the Society of Maternal-Fetal Medicine (SMFM) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) stand united in their endorsement of folic acid for NTD prevention. It’s a resounding vote of confidence in the power of evidence-based supplementation.

Empowering expectant mothers with knowledge

In the labyrinth of pregnancy-related information, clarity is key. By demystifying the realm of prenatal vitamins, debunking myths surrounding the MTHFR mutation, and championing evidence-based practices, we pave the way for informed choices and healthier pregnancies.

Remember this: when it comes to prenatal nutrition, there’s no substitute for evidence-based care. So, here’s to prioritizing folic acid and making informed choices based on solid scientific data.

Dr. Garcia is an REI at Markham Fertility Centre, located in Markham, Ontario, Canada.