By: Talking Nutrition Editors
Today, experts increasingly emphasize the importance of diet and nutrition – from preconception to birth and beyond – on both maternal and infant health.1 Observational studies have demonstrated strong links between inadequate nutrient intakes before pregnancy and adverse infant outcomes, including higher risk of preterm birth or birth defects, which can have lifelong consequences.2 For women who are planning to conceive, a healthy diet is key. However, poor nutrition is still common among women of reproductive age in both high- and lower-income countries, with diets often falling short of nutritional recommendations due to modern dietary preferences, like processed foods and refined grains.1
Folate is one of the most important nutrients every mother-to-be should consider supplementing with to help promote a healthy pregnancy and the lifelong health of their baby. Here, we explore the science-based benefits of folate supplementation before and during pregnancy and how advancements in dietary supplement formulations are helping to optimize health outcomes for mom and baby.
Folate (vitamin B9) is an essential nutrient that is especially important for women trying to conceive. It is well established that adequate folate status reduces the risk of neural tube defects (NTDs) in babies. NTDs can lead to lifelong debilitating conditions such as spina bifida, and even stillbirth in severe cases – thus folate is strongly recommended in all women of childbearing age, especially those who are trying to conceive.
While a balanced diet with plenty of leafy greens and pulses is usually sufficient to maintain healthy folate levels, supplementation is advised for all women of childbearing age to ensure women are achieving adequate levels prior to becoming pregnant.3 Women of childbearing age are recommended to take 400 micrograms (mcg) folic acid per day even if they are not actively trying to get pregnant because folic acid can only prevent NTDs if it is taken before the neural tube closes in the first few weeks of pregnancy.4 Supplementation is important because more than 40% of women of childbearing age globally do not have sufficient blood folate levels to protect against NTDs.5
There are primarily two forms of folate: folic acid and methylfolate (also known as Metafolin®). Folic acid is the form that was studied and clinically shown to prevent neural tube defects, and is the form commonly found in fortified foods and dietary supplements. However, folic acid must go through a series of steps to be converted to methylfolate – the active compound. Up to 50% of people (depending on the population) have limited capacity to convert folic acid to methylfolate due to a genetic polymorphism (MTHFR mutation) that inhibits enzyme activity. In these cases, the unmetabolized folic acid cannot be utilized in the body.
Methylfolate on the other hand, is already active, more bioavailable and absorbed faster than folic acid. Studies show methylfolate increases serum folate levels more than an equal dose of folic acid.6 One research group found that methylfolate increases plasma folate more effectively than folic acid in women with the MTHFR polymorphism.7 When both methylfolate and folic acid are combined, the threshold blood folate level to prevent neural tube defects (>906 nmol/L) can be reached in only four weeks, half the time of folic acid alone.
Additionally, emerging evidence suggests methylfolate may support fertility, especially in infertile women with the MTHFR gene mutation.8 In one study, 100 women with the MTHFR mutation and a history of at least two prior early miscarriages were randomized to receive either 5 mg of folic acid or 1000 mcg methylfolate daily.9 The results were encouraging. Incidences of miscarriage decreased by 16% and full-term births increased by 52% in the methylfolate group. A further trial demonstrated that methylfolate plus vitamin B12 supports higher chance of conception and full-term pregnancy compared to folic acid in women undergoing assisted reproduction.10 With this in mind, the benefits of methylfolate during preconception and pregnancy cannot be underestimated. This natural form of folate could be a viable alternative – or complement – to folic acid supplementation or fortification.
Nutrition plays an important role in preparing women for a healthy conception and pregnancy which helps to reduce the risk of negative birth outcomes that can have long-lasting consequences for both the mother and her baby.
Want to learn more about the role of maternal nutrition in preconception and prenatal health? Read our new whitepaper to explore the latest science and solutions designed to meet varying nutritional needs throughout the motherhood journey.
26 July 2023
5 min read