The Ins and Outs of Folic Acid and Folate for Fertility and Pregnancy

folic acid pregnancy folate

As an osteopath I take a keen interest in all areas of health and wellbeing. When it comes to supplements, it feels like a minefield. A lot of information conflicts with other advice, and it can be difficult to make decisions, let alone make recommendations as a healthcare professional! Recently I have been learning more about folic acid, which is commonly recommended for pregnant women. As well as this being relevant to my pregnant clients, there is a current theory that it is linked to tongue tie in babies, which I often treat when linked to feeding issues.

What is folic acid?

Folic acid is one of the main supplements that is recommended before and during pregnancy. Folic acid is the synthetic version of folate, or vitamin B9, which is naturally occurring in various foods (see below). The usual guidelines recommend 400 micrograms of folic acid a day. There are a number of fortified foods such as cereals and margarine which have added folic acid.

Why is it important?

Folic acid has been proved to prevent neural tube defects (which affect the brain and spinal cord) and cause conditions such as spina bifida since the 1900s. Folic acid is also beneficial for the heart, as it improves the elasticity of the blood vessels.

Why can’t I just eat my nutrients instead of taking supplements?

Even if you are eating varied and nutritious foods, issues such as soil quality and food transportation can affect the quality of nutrients. It’s always better to consider the back-up support of a supplement, as well as seeing a nutritionist/ naturopath to make any dietary improvements needed.

Food sources for folate

Green leafy vegetables such as spinach, kale and chard (go for organic if you can as they can often be highly sprayed with pesticides)

Organic eggs

Liver (which is not recommended in pregnancy)

Brown rice

Cooked lentils


Cantaloupe melon

Folic acid has been present in fortified cereals since 1998, but these are often heavily processed foods and therefore aren’t quite the healthy options that they may seem. Also the folic acid used is synthetic so one can question how much the body actually absorbs.

Margarine also has folic acid added to it. It’s not an ideal fat source, so lean towards natural oils such as coconut or rapeseed instead, or grass-fed butter.

When should I take it?

At least 3-4  months before trying to conceive to get the body into the best possible state. The common dose is 400 microgram dose during pre-conception and pregnancy. Many supplement companies suggest the same product for pre-conception care as for pregnancy and will either be labelled for fertility or for pregnancy.

What are the issues with folic acid versus folate?

At this point let me introduce Henrietta Norton, an experienced Nutritionist and creator of a food state brand of supplements called Wild Nutrition. I asked her for her views on whether folate or folic acid was recommended.

She told me that “Natural Folate has been shown to transfer into the placenta more effectively so is more supportive during pregnancy after the first 12 weeks especially. All products in our Wild Nutrition range provide folate rather than folic acid. Under the new labelling legislation, we currently have to state it as folic acid. It’s frustrating and confusing for the customer and I think it is about the change again - so we will be relabelling at some point to change this to folate. The very nature of the food-state process ensures that Vitamin B9 is only found in methylfolate and 5-formyl tetrahydrofolate form and therefore this supports those patients who may be the carrier of MTHFR SNP.”

MTFHR (methylenetetrahydrofolate reductase gene) is a gene variant or mutation, that can checked for with blood tests. For people who test with the variant, they are recommended to take an activated form of folate containing methylfolate rather than folic acid when trying to conceive, as folic acid can’t be absorbed correctly. The gene is thought to be linked to a number of conditions including fibromyalgia, schizophrenia and autism. Tongue tie is also potentially linked to the MTFHR gene and folate deficiencies.

Tongue tie and folic acid

Ankyloglossia or tongue tie is when the tongue is attached to the floor of the mouth, causing restricted movement. Tongue tie may be linked to the MTFHR and the use of folate is being considered in preference to folic acid. This is a consideration for women who are trying to conceive, and choosing a good quality supplement to support their well-being.

If you would like to know more about tongue tie, read my previous post here:

For more information on nutrition with Henrietta Norton and her range of  food-state supplements, visit

Further reading