Folate: A foundation for human development

Folate is an essential vitamin required for numerous bodily functions, including neurological health, homocysteine regulation, and the formation of glial cells and neurotransmitters. During pregnancy, its demand rises significantly as it aids in the growth of the placenta and fetus while offering protection against neural tube defects and other birth complications like cardiovascular issues, cognitive dysfunction, low birth weight, and even certain cancers.

The role of Folic Acid and its limitations

Folic acid, a synthetic and oxidised version of folate, is commonly found in dietary supplements and fortified foods. While it is intended to serve as a replacement for natural folate, its metabolism differs significantly. Folic acid must undergo several metabolic steps within the body to become biologically active as tetrahydrofolate (THF). Unfortunately, this conversion process is slow and can easily saturate, leading to the inhibition of absorption. The accumulation of unmetabolised folic acid can potentially mask vitamin B12 deficiencies and may result in various physiological issues.

Implications for infant neurodevelopment

Studies have shown that very high doses of folic acid supplementation during pregnancy may have adverse effects on infant neurodevelopment. As a result, healthcare practitioners must exercise caution when recommending folic acid doses to pregnant women to ensure optimal outcomes for both the mother and the child.

The rise of 5-MTHF and Folinic Acid as alternatives

In the pursuit of safer and more effective alternatives to synthetic folic acid, two notable candidates have emerged: 5-methyltetrahydrofolate (5-MTHF) and folinic acid. 5-MTHF is a biologically active form of folate that naturally occurs in the body and is the most abundant form found in plasma. Its superior bioavailability and effectiveness make it an attractive option for supplementation during pregnancy.

Folinic acid, on the other hand, is a 5-formyl derivative of THF and is found naturally in certain foods. Unlike synthetic folic acid, folinic acid readily converts to THF without requiring additional enzymatic action. Furthermore, it remains unaffected by certain pharmaceuticals, making it a more stable and reliable choice for pregnant women.

Folate-rich foods

Rich sources of folate from foods can be found in green, leafy vegetables, legumes, fruits, sprouts, and liver. For women of childbearing age, the recommended daily intake of folate is 400ug/day. However, during preconception, pregnancy, and breastfeeding, it is recommended to supplement with approximately 600mcg of folate/day to meet the increased demands.

As research continues to shed light on the importance of folate during pregnancy, the differences between supplementation with folate, folic acid, and folinic acid have become increasingly evident. While folic acid has been a longstanding choice in dietary supplements and food fortification, its limitations and potential adverse effects on infant neurodevelopment warrant a closer examination of alternatives. 5-MTHF and folinic acid present themselves as promising options, offering better bioavailability and reduced risks compared to synthetic folic acid. However, the challenge of affordability remains, emphasising the need for comprehensive and individualised prenatal care to ensure the best outcomes for both mothers and their precious newborns.