The terms folate and folic acid are often used interchangeably. They are both forms of vitamin B9, but there is an important difference between them. Please continue reading to find out which is better during pregnancy - folate or folic acid. 

What is the difference between folic acid vs folate?

Folate and folic acid are the same nutrient. However, folate is the natural form of vitamin B9, a water-soluble vitamin that is found in many foods. Folic acid is the synthetic form of vitamin B9 which is added to foods and sold as a supplement. Folic acid, which is found in supplements and fortified foods, is better absorbed by the body (up to 85%). In contrast, only around 50% of folate, which naturally occurs in food sources, is absorbed.

What role does folic acid play in the body?

Vitamin B9, also called folic acid and folate, is an essential nutrient. It is one of the eight B vitamins that are water-soluble and not stored in the body. Also called the B-complex vitamins, they help the body use fats and proteins and convert food into energy. They are also needed for healthy skin, hair, and eyes, a healthy digestive system and nervous system, and red blood cell formation.

In particular, folate and folic acid (vitamin B9) is vital for healthy brain function and the formation of DNA and RNA genetic material. Vitamin B9 is especially important when cells and tissues are undergoing rapid growth, such as during infancy, adolescence, and pregnancy. 

Vitamin B9 works with vitamin B12 to make healthy red blood cells. It also works with vitamins B6 and B12 to keep the levels of an amino acid called homocysteine under control in the body. Elevated homocysteine levels are linked to an increased risk of heart disease and stroke. 

There is scientific evidence that low folate levels are associated with other health problems, such as an increased risk of cancer. Also, low levels of vitamin B9 in pregnant women are associated with an increased risk of birth defects.

Should I get folate or folic acid supplements?

As mentioned, folate occurs naturally in foods. Folic acid is the synthetic form of folate found in supplements. You can get vitamin B9 from natural food sources like leafy green vegetables or from a multivitamin, B vitamin complex, or prenatal vitamin. Folic acid is also sold separately; however, it is better to take it as part of a multivitamin because the body needs other B vitamins for it to work properly.

What form of vitamin B9 is in fortified foods?

It is mandatory to fortify foods, which means to add nutrients, with vitamin B9 in many countries, including the United States. All grains, cereals, and many other food products in the US are fortified with folic acid. 

What are the signs and symptoms of folate deficiency?

Risk factors for low levels of folic acid include inflammatory bowel disease (IBD), celiac disease, and alcoholism. Certain medications are also linked to a higher risk of folic acid deficiency. Signs and symptoms of low levels of folic acid in the body include:

• Poor growth
• Tongue and gum inflammation
• Loss of appetite
• Diarrhea
• Shortness of breath
• Mental sluggishness
• Memory problems
• Irritability

Do I need to take a folic acid supplement?

Most people do not need to take dietary supplements containing folic acid because this essential nutrient is found in many foods and fortified processed foods. So, if you eat a varied diet, you probably do not need this vitamin in supplement form. 

However, people with digestive disorders and alcoholism are at an increased risk of folic acid deficiency. Also, pregnant women need a higher folate intake to support the developing fetus. Lastly, people with a variation in the MTHFR gene (used to keep homocysteine levels in a tolerable range) cannot convert folate to its active form and need to take folic acid supplements.

The recommended daily intake of dietary folate is as follows:

• 0-6 months: 65 mcg
• 7-12 months: 80 mcg
• 1-3 years: 150 mcg
• 4-8 years: 200 mcg
• 9-13 years: 300 mcg
• 14-18 years: 400 mcg
• 19+ years: 400 mcg
• Pregnant women: 600 mcg
• Breastfeeding women: 500 mcg

Dietary folate equivalents are units used to account for the lower availability of natural folate in food compared to synthetic folic acid used in supplements. Your doctor can tell you how much folate to take to maintain adequate folate levels. They can also evaluate ingredients and suggest the best vitamin supplements for you.

It is worth noting that while enough folate is important, too much folic acid can cause problems such as masking a vitamin B12 deficiency. For this reason, you should only take vitamin supplements under your doctor’s supervision. 

What are food sources of folic acid?

Folate, the naturally occurring form of vitamin B9, is found in whole foods like dark green leafy vegetables, spinach, broccoli, romaine lettuce, asparagus, Brussel sprouts, mustard greens, turnips, beets, beans (soybeans, lima beans, white beans, mung beans, kidney beans), avocado, root vegetables, citrus fruits, orange juice, whole grains, Bulgur wheat, wheat germ, beef liver, salmon, peanuts, sunflower seeds, milk, eggs, and fortified foods like breakfast cereals.

Do all pregnant women need a folic acid supplement?

All pregnant women should take a folic acid supplement to prevent birth defects and ensure a healthy pregnancy. Pregnant women need more folic acid to support the development of the neural tube, a structure in the embryo from which the baby’s brain and spinal cord develop. A folate deficiency during pregnancy can lead to brain malformations and neural tube defects such as spina bifida and cleft palate. 

Pregnant women need 600 mcg of folic acid per day. Notably, many neural tube defects can occur in very early pregnancy, even before a woman realizes she is pregnant. Therefore, women of reproductive age who plan to become pregnant in the near future should get at least 400 mcg per day of folic acid. 

A prenatal vitamin contains the recommended amount of folic acid for pregnant women. Taking it can lower the risk of having a baby with neural tube defects by 70-100%. In addition, a folic acid supplement can help to prevent miscarriage and lower the risk of autism, severe language delay, and emotional problems in the offspring. 

Which is better for pregnancy - folate or folic acid?

Folic acid supplementation is better for pregnancy. This is the synthetic form of vitamin B9. It is better absorbed than the natural folate found in food sources.

Do I need to take folate if my prenatal has folic acid?

Prenatal vitamins contain folic acid, but they are not a replacement for the natural folate found in a healthy, well-balanced diet. Taking a prenatal vitamin can give you and your baby the vital boost of nutrients needed for a healthy pregnancy. Your healthcare provider may recommend taking a folic acid supplement in addition to your prenatal vitamin, depending on your dietary habits. 

References:

1. https://www.hsph.harvard.edu/nutritionsource/folic-acid/
2. https://www.mountsinai.org/health-library/supplement/vitamin-b9-folic-acid