My sister (who’s not a doctor) told me it’s better to take prenatal vitamins with folate instead of folic acid because the body absorbs folate better. I asked my doctor, and she said it didn’t make a difference. Does it make a difference? Seems like there might be some truth to this after a quick Google search.
-Alexa
This is kind of an interesting space, so bear with me.
Folate is a nutrient. It is a very important one for fetal development; notably, it supports neural tube development. Pregnancies where the mother has low levels of folate are at higher risk for spina bifida and related conditions.
Folate is found in food — liver, leafy greens, eggs — but it’s generally thought that average levels may not be high enough among many pregnant women. Therefore, it is recommended that pregnant women do something to increase their folate levels.
The typical way to do this is with folic acid. Folic acid is a supplement found in vitamins and many food additives. It’s the synthetic form of this compound, and your body breaks it down into folate. The alternative, which has gotten a lot of traction recently, is to take a form of folate directly. Some of the fancier, more expensive prenatal vitamins emphasize their inclusion of this form of folate rather than folic acid (here is an example). Of course, the pitch is that this form of folate is better.
There are some different supposed reasons that it might be better. One is the possibility that certain people do not break down folic acid well, due to a genetic variation. Folic acid may interact with particular drugs and may also make it more difficult to detect vitamin B12 deficiency, which occurs in specific types of anemia. However: it is difficult to know how significant any of these issues are, or how widespread.
Direct evidence on the superiority of this form of folate supplementation is lacking. Research comparing the two approaches to supplementation seems to indicate that they have similar effects on folate levels. It is also important to note that we have good randomized data showing huge reductions — 70%, 90% — in the risk of neural tube defects as a result of folic acid supplementation. Conclusion: the standard form of supplementation works extremely well.
Is there any reason not to use folate rather than folic acid? I think the main one is cost — folic acid is very cheap, so prenatal vitamins that use folate instead are often (maybe not always) more expensive.
I am basically with your doctor here. It could be true that for a small share of people, folate might be better, but for the vast majority, it almost certainly doesn’t matter. Could you switch your prenatal? Sure. But it’s probably just a few dollars wasted.
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