Finding the Right Folate: Supporting a Healthy Pregnancy
If you’ve had recurrent miscarriages or pregnancy complications, you’ve probably been told to take more folic acid. But what if that advice isn’t actually right for you? A 2021 study sheds light on how different forms of folate affect pregnancy outcomes, particularly for those with MTHFR gene variations. (Also do you know if you have this gene??? Worth checking on!)
The results?
Let’s just say they might change the way we approach prenatal supplementation.
The Study: Folic Acid vs. Methylfolate
Researchers studied 100 women with MTHFR variations who had experienced at least two consecutive first-trimester miscarriages. Participants were given either:
5,000 mcg/day of folic acid (the synthetic form of folate found in most prenatal vitamins) or
1,000 mcg/day of methylfolate (the bioavailable form that bypasses MTHFR-related conversion issues)
All women were followed through their pregnancies, and those with other known causes of miscarriage—like uterine anomalies or clotting disorders—were excluded. The results were striking.
Pregnancy Outcomes: A Stark Contrast
The women taking folic acid had significantly higher rates of miscarriage and complications:
54% miscarried
44% had pregnancy complications
14% developed preeclampsia
18% had premature rupture of membranes (PROM)
12% experienced preterm labor
Only 22% carried to full term
Meanwhile, the women taking a lower dose of methylfolate fared much better:
Only 16% miscarried
22% had pregnancy complications
6% developed preeclampsia
8% had PROM
8% had preterm labor
60% had a full-term pregnancy—nearly three times the rate of the folic acid group!
Why Does This Matter?
If you have an MTHFR gene variation, your body may struggle to convert folic acid into its usable form, leading to unmet folate needs and increased risks of miscarriage, preeclampsia, and other pregnancy complications. Methylfolate, on the other hand, is already in the active form, making it more effective for those with MTHFR mutations.
Should You Switch to Methylfolate?
If you have a history of recurrent miscarriage, unexplained infertility, or pregnancy complications, you may want to discuss methylfolate vs. folic acid with your provider. Some key takeaways:
Not everyone needs to avoid folic acid, but if you have an MTHFR variation, methylfolate may be the better choice.
Many standard prenatal vitamins contain folic acid—check your labels if you’re considering a switch.
Testing for MTHFR mutations is not routine, but if you’ve had pregnancy losses or complications, it may be worth discussing.
The Bottom Line
For decades, high-dose folic acid has been the go-to recommendation for preventing neural tube defects and supporting pregnancy. But for those with MTHFR variations, a more personalized approach may be needed. If you’re struggling with pregnancy loss or complications, it’s worth exploring whether methylfolate could be a better fit for your body—and your baby.
Love,
Emily
