Folic Acid and Pregnancy: Why Is It So Important?

Are you thinking of starting a family? Good nutrition is key for conception and a healthy pregnancy. One of the most widely talked about nutrients for pregnancy care is folic acid or folate. Let's look into the connection between folic acid and pregnancy and find out why it’s so important before and during pregnancy. 

 

What is folate?

Folate, also known as vitamin B9, is part of the B-vitamin family. It’s an essential nutrient for healthy DNA replication, protein synthesis, and the development of the nervous system. 

Folate is essential during conception and pregnancy because it helps support sperm and egg quality and prevent birth defects, specifically neural tube defects like spina bifida [1]. 

The mum-to-be needs optimum levels of folate too, to prevent anaemia and peripheral neuropathy during pregnancy [1].

The risk of developing any of these issues is minimised by optimising folate intake, whether from folate-rich foods or supplements.

Are folate and folic acid the same thing?

When it comes to taking folate as a supplement, there are 2 forms to choose from: folic acid or methylfolate.

Folic acid is the man-made, synthetic form of folate. Your body has to convert folic acid into methylfolate to make it usable. The problem is many people struggle with this conversion due to genetic variations affecting the enzyme that performs the conversion (MTHFR – methylenetetrahydrofolate reductase). When they take folic acid it remains unconverted and left to float around in the bloodstream.

Methylfolate on the other hand is made from tetrahydrofolate found in foods (see the Top 6 foods for folate section below). Unlike folic acid, methylfolate can cross cell membranes and the blood-brain barrier, making it a far more convenient and effective form to use.

How does folate help you get pregnant?

Folate isn’t a fertility booster, but it is an essential nutrient for healthy conception and pregnancy. Fertility care focuses on optimising all the vitamins and minerals both partners need to conceive and enjoy a safe and healthy pregnancy. Folate, and the role it plays in DNA replication, cell division, and red blood cell production is part of this.

Folate and sperm health

Most recommendations for folate supplementation focus on the new mum but it’s good to remember that the new dad contributes half the genetic material to the baby, and his folate status is just as important. 

Research in this area highlights links between folate status and sperm quality and sperm development [2]. Low folate levels are associated with low sperm concentrations and an increased risk of congenital problems [2]. With this in mind, optimising dietary and supplemental folate for the father-to-be is an important part of pre-conception care.

Folate and neural tube defects 

The Institute of Medicine's Food and Nutrition Board of the National Academy of Sciences recommend that women take 400 mcg of folate each day while planning a pregnancy and during the first trimester to reduce the risk of neural tube defects [3]. This is in addition to maximising food sources of folate.

Neural tube defects occur during the first 3 months of pregnancy when the brain and spinal cord are developing. 

Folate supplementation may also help reduce the risk of orofacial clefts like cleft palate, which develop in early pregnancy [4].

Folate and congenital heart disease: protecting your baby’s heart

Approximately 13 babies a day are born with congenital heart disease in the UK. This is a sad reality for these babies and their parents, however hope is on the horizon for expectant parents as research shows that maternal folate supplementation can significantly decrease the risk of these heart issues [5]. We hope to see this number decline in years to come with greater awareness of the role folate plays during pregnancy. 

Top 6 foods for folate

Folate is found in various foods, but it's worth noting that it can be sensitive to heat and water, so it’s important to prepare folate-rich foods gently. 

Some excellent sources include:

• Vegetables – especially green veg like broccoli, spinach, kale, asparagus and green beans.

• Fruits - avocado, oranges, berries, and bananas.

• Legumes like lentils, chickpeas, split peas.

• Eggs.

• Nuts.

• Fortified foods.

There’s no guarantee that you will get enough folic acid from food alone, so a supplement is important. If you have morning sickness in early pregnancy, it may be difficult to eat enough food to get the folic acid you need.

When should I take folate for pregnancy?

It's recommended to begin taking a daily folate supplement 3 months before actively trying to conceive and throughout the first trimester. If you haven't used folic acid or folate supplements before, start as soon as you discover you're pregnant.

Opt for a supplement with at least 400 micrograms (mcg or µg) of methylfolate, the most active form of this nutrient.

Folate and breastfeeding

Folate continues to support mother and baby health even after pregnancy. Folate is a normal component of breast milk and is safe for both the mother and baby when taken as a supplement during breastfeeding. It passes into breast milk in small amounts, which help ensure the baby receives adequate levels during this critical period of growth and development.

Benefits of folate for new mums

Maintaining adequate folate levels is essential for breastfeeding mothers for their own health and to ensure the quality of their breast milk. Folate works with iron and vitamin B12 in red blood cell production and helps prevent anaemia, which can be a concern post-pregnancy. It also contributes to the new mum’s overall well-being, which is crucial for effective breastfeeding and nurturing the newborn.

If you're looking for a quality folic acid/folate supplement, look no further than Ethical Nutrition's Methylfolate Folic Acid. It's never too early to start prioritising you and your baby's health during this special journey!

 

References

1. Greenberg, J. A., Bell, S. J., & Guan, Y. 2011. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention. Reviews in Obstetrics and Gynecology, 4(2), 52. https://pmc.ncbi.nlm.nih.gov/articles/PMC3218540/ 

2. Hoek, J., Willemsen, S. P., & Schoenmakers, S. 2020. Paternal Folate Status and Sperm Quality, Pregnancy Outcomes, and Epigenetics: A Systematic Review and Meta‐Analysis. Molecular Nutrition & Food Research, 64(9), 1900696. https://doi.org/10.1002/mnfr.201900696 

3. National Institutes of Health, 2022. Folate. [online] Available at https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#:~:text=The%20FNB%20advises%20all%20women,published%20similar%20recommendations%20%5B36%5D. [Accessed 30 May 2025].

4. Wahl, S. E., Kennedy, A. E., Wyatt, B. H., Moore, A. D., Pridgen, D. E., Cherry, A. M., Mavila, C. B., & Dickinson, A. J. 2015. The role of folate metabolism in orofacial development and clefting. Developmental Biology, 405(1), 108-122. https://doi.org/10.1016/j.ydbio.2015.07.001 

5. Feng, Y., Wang, S., Chen, R. Tong, X., Wu, Z., Mo, X. 2015. Maternal Folic Acid Supplementation and the Risk of Congenital Heart Defects in Offspring: A Meta-Analysis of Epidemiological Observational Studies. Scientific Reports 5, 8506 (2015). https://doi.org/10.1038/srep08506