You may have heard the buzz around all the new research on Folic acid. If you’re pregnant or looking to conceive, it can feel like a minefield. Folic acid, folate or Folinic acid — what’s a mum-to-be to do?

Folinic acid vs. Folic acid — what’s the difference?

Vitamins often take more than one form — if you’re an avid label reader, you may notice a bunch of numbers and letters on your prenatal vitamin bottle. L-MTHF, 5-MTHF, levomefolic acid, calcium folinate, folinic acid, folic acid - yeah, they all mean the same thing, sort of. If you’re getting the feeling that it’s complicated, you’d be right - but let’s break it down to the most common types of folate you’re likely to come across and how they differ:

Folate is the naturally occurring water-soluble vitamin, also known as vitamin B9. It’s found abundantly in the diet.

Folic acid is the synthetic form we’re familiar with as it’s often added to wheat flour (known as ‘fortification’) and other products in some countries. It’s also the form of folate you’re most likely to be prescribed. Why? When the crucial role of folate in reducing the risk of neural tube defects in pregnancy was first discovered, it was a huge win for public health. Naturally, women were scrambling to make sure they were getting enough folate for a healthy pregnancy. The easiest way to do this, it seems, was through supplementation - synthetic folic acid began being produced for this purpose. Most of the evidence around folate and pregnancy up until very recently centres around clinical trials using folic acid. That is changing - very, very slowly.

Now to Folinic acid - the (relatively) new kid on the block. Folinic acid provides an easily absorbed version of folate. How is it able to be better digested than Folic acid? I hear you ask. Well, Folinic acid goes through a process known as “activation”. Activation, which we’ll explain further below, takes the burden off the body to process Folic acid through the liver - or risk it not being processed at all!

The problem with Folic acid

Let’s start first with how Folic acid is metabolised in the body. While Folate is absorbed in the gut, folic acid must first undergo conversion to its ‘active’ form of 5-methyltetrahydrofolate (5-MTHF) in the liver. If your liver is already snowed under with its workload, then it’s not able to convert folic acid to its usable form of Folate - which means you could be missing out on many of its benefits.

Secondly, if you’re one of around 40% of the population with a genetic variant known as MTHFR, there’s some debate that the ability to metabolise (and therefore use) folic acid may be impaired. If the body doesn’t metabolise Folic acid properly, there’s a risk that it can build up in your body and cause a number of issues, including increased homocysteine and reduced vitamin B12 levels. Homocysteine isn’t something you’re likely to hear in everyday conversation - it’s an amino acid that occurs in the process of metabolism - and the takeaway of it is that it’s also a marker that can be tested for in the blood. Why would you ever test for it? High homocysteine levels are useful in showing up any potential B vitamin deficiencies, as well as an increased risk of certain chronic diseases.

Benefits of Folate in preconception care and pregnancy

We all need folate for lots of important processes in the body, including red blood cell production, growth and repair of cells, and DNA replication - all processes that are front and centre when it comes to growing a fetus.

Raising Folate levels during the preconception phase has been shown to reduce the risk of pre-term birth. A deficiency of folate has also long been associated with health issues for mothers, such as anaemia, and for the fetus, including congenital abnormalities such as neural tube defects. (Greenberg, et al, 2011) Because NTDs happen in the very early stages of pregnancy, preconception care with an appropriate form of Folate supplementation is all the more crucial.

During the postpartum period or ‘fourth trimester’ prenatal vitamins continue to be a vital support to mother and baby. While your friends and family take time to fuss over the new addition, your own needs for support and consideration shouldn’t fall by the wayside. Many new mothers may not consider their own needs - including the nutritional needs of the body during this time of repair and replenishing. Your body is still hard at work healing and adjusting, so a prenatal vitamin can continue to provide that extra support.

While breastfeeding, many nutrients are given over to the baby, leaving the mother depleted - Folate is no exception. If you choose to breastfeed, continuing on with your prenatal vitamin can help to prevent a number of nutrient deficiencies, including Folate.

What to look for in your prenatal

Along with taking a close look at prenatal nutrition and ensuring you meet your recommended daily intake of important nutrients for preconception and pregnancy, it’s important to know what’s in your prenatal vitamin.

Make sure you’ll be getting enough folate from your prenatal. Based on many years of research, the recommended daily intake of Folate during pregnancy is 500 micrograms (and 600 micrograms for breastfeeding). (Gropper, et al, 2013)

Is your Folate activated? When Folate is activated, it’s immediately available for use in the body - this is often referred to as ‘bioavailable’. In preconception care, this means that improving your Folate levels in preparation for pregnancy can be done quickly and with confidence. In pregnancy, Folinic acid is immediately available to the mother and fetus. (Ferrazzi, et al, 2020)

Photography by Ilsa Wynne- Hoelscher Kidd