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As soon as you decide you’re trying for a baby, the first step (after stopping any birth control you’re using) is to take prenatal vitamins. But with so many supplement types and brands out there, how do you know which vitamins are the right ones for you? There’s a lot of information to wade through.
First, you should know that a key ingredient you need to support a healthy pregnancy is folate, or vitamin B9. It can be found in whole foods like leafy, green vegetables, fresh fruits, peanuts, beans, sunflower seeds, and eggs. However, during pregnancy, you need more (about 600 micrograms total each day) than you can find in your diet, according to Dorothy Bestoyong, DO, a Florida-based OB/GYN. That’s why folate is also sold in the synthetic form of folic acid supplements, and a 400 microgram daily dose is recommended. “The primary goal of folic acid is to prevent neural tube defects during pregnancy,” says Dr. Bestoyong. “And if there is a history of a neural tube defect in a previous pregnancy, it is recommended to take 4 milligrams 3 months prior to pregnancy.”
More recently, there’s been a trend toward taking a supplement containing methylated folate instead of folic acid, because it is considered more “natural” and similar to the form of folate found in food (essentially, folic acid eventually breaks down to methylated folate in the body). It’s created a bit of a debate about which is better for you, and how you should make the right choice of prenatal vitamins. We’re here to break down the differences and give you the facts about both to help you decide on the best form of this essential vitamin for you.
Pros of folic acid
In many cases, your OB/GYN will recommend that you take folic acid during pregnancy because it is still considered the gold standard by the American College of Obstetricians and Gynecologists (ACOG) and by the CDC, explains Dr. Bestoyong. There is so much research that’s already behind it, and there have been many studies detailing its support of embryonic development.
Not only has it been studied to prevent neural tube defects, or birth defects affecting a baby’s brain and spine, but folic acid also ensures healthy growth and functioning of cells, including red blood cells, according to ACOG. Since you can’t obtain enough folate from diet alone, supplementation of the nutrient is recommended, and historically, that has been folic acid.
Cons of folic acid
There is a gene called MTHFR that gives your body the information it needs to break down and utilize folate. It’s fairly common to have a genetic mutation for MTHFR, which can potentially make folic acid more difficult to process, explains Anna Bohnengel, MS, RD, LD, a registered dietitian nutritionist based in Oregon and founder of Fertility Nutritionist. Some research has found a small increased risk of neural tube defects like spina bifida associated with the MTHFR mutation, but having the genetic variation does not necessarily mean you or your children will have neural tube defects. The CDC believes that there is not enough evidence that you won’t be able to safely take and process folic acid if you have the MTHFR variation.
As a nutritionist, Bohnengel does recommend taking methylated folate supplements if you do have the genetic variation, to ensure that your body easily absorbs the folate and doesn’t have difficulty processing folic acid. Most people won’t have clear signs or symptoms of whether or not they have the variation. “It’s not exactly routine in preconception care to test for this, and testing itself poses an additional financial (and time!) burden,” Bohnengel says. If you’ve done a 23andMe or other genetic testing kit, you can check out your “raw genetic data” for more information about health markers and get an answer about the MTHFR variation.
If it turns out that you do not have the MTHFR mutation, there should be no harmful health consequences of taking a folic acid supplement, says Bohnengel.
Pros of methylated folate
“Folic acid is not in the most metabolically active form, meaning your body needs to break it down into methylated folate before it's usable,” Bohnengel says. Because it doesn’t have to break down, methylated folate can be immediately available to the person carrying the pregnancy and the fetus, she explains.
Beyond its potential benefits for prenatal health, methylated folate supplementation may also be helpful in people of all genders who have unexplained infertility, which may be due to low folate availability, according to a 2022 study.
On top of that, methylated folate is known to be safe. “There are no known side effects to taking methylated folate if taken in appropriate doses,” says Bohnengel.
Potential cons of methylated folate
So many of the research trials related to preventing neural tube defects have been done using folic acid supplementation, so there is not enough research on methylated folate, Bohnengel says. “There has been no proven scientific data from randomized controlled trials showing that methylated folate is superior to folic acid in terms of prevention of neural tube defects,” says Dr. Bestoyong. And because of that, folic acid has continued to be the gold standard recommended.
Taking methylated folate is not detrimental to your health, but it may not be within every budget. “Folic acid supplements are widely available and accessible, whereas methylated folate supplements are usually very expensive,” adds Dr. Bestoyong.
The bottom line
There is no judgment about whether you decide on folic acid or methylated folate supplements. It’s up to you to choose a supplement based on your body, your family, and your budget. “Like so many health issues, there are pros and cons, not rights or wrongs. Ultimately, you get to make an informed decision about what’s best for you and your babe-to-be,” Bohnengel says.
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.