Folic acid supplementation: why is it essential before and during pregnancy?

Folic acid and pregnancy: why should you take supplements even before getting pregnant?

Folic acid , or vitamin B9 , is a micronutrient essential for proper cellular function , particularly during phases of rapid division such as early pregnancy. However, our bodies cannot produce or store it efficiently. Supplementation is therefore essential to prevent certain risks for the fetus , particularly brain malformations (neural tube closure defects).

What is folic acid?

Vitamin B9, called folate in its food form , is not produced by the body and must therefore be provided by food (leafy vegetables, liver, etc.). However, this natural form is sensitive to oxidation, air, and heat, resulting in a loss of approximately 75% between the harvesting of a food and its consumption. In addition, its bioavailability (the proportion actually absorbed and used by the body) is only approximately 50%. To compensate for this instability, a more stable synthetic form has been developed: folic acid , whose bioavailability reaches 85%. Finally, whether folates or folic acid, these compounds must be transformed by the body into their active form, 5-methyltetrahydrofolate (5-MTHF) , in order to fulfill their physiological functions.

Folic acid, what is its role during pregnancy?

Folic acid is involved in DNA synthesis, cell division, and nervous system development. During pregnancy, it becomes essential in the first few weeks, as this is when the baby's neural tube, which will become the brain and spinal cord, begins to form.

Inadequate intake can lead to serious birth defects such as anencephaly (absence of the brain) and spina bifida (failure of the spine to close). These abnormalities often occur before pregnancy is even confirmed, hence the importance of early supplementation, ideally as soon as the desire to conceive is made.

When should I start taking folic acid?

Health authorities recommend a daily supplementation of 400 µg of folic acid as soon as pregnancy is desired (or 5 mg/day in case of a history of neural tube closure defects).

EFSA in 2017 and then ANSES in 2021 reassessed the satisfactory intake for women likely to be pregnant at 600 µg/day.

This preventive measure is all the more justified since 75% of women of childbearing age have folate intakes below nutritional recommendations.

Why do some women have difficulty absorbing traditional folic acid?

To exert its beneficial effects, synthetic folic acid (the form commonly used in supplements and medications) must be converted by the enzyme MTHFR into its active form: 5-MTHF (5-methyltetrahydrofolate).

However, approximately 1 in 2 women have mutations in the MTHFR gene that reduce this conversion capacity. In this case, conventional folic acid is poorly metabolized, compromising the effectiveness of supplementation.

Which form of folic acid should be preferred for good assimilation?

To circumvent the defects in folic acid assimilation linked to this mutation, it is possible to directly use the 5-MTHF form (active form of vitamin B9) which has better bioavailability.

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This article is for informational purposes only and does not replace consultation or advice from your doctor. Seek professional advice before starting any dietary supplement.