There is often a lot of planning involved when you are trying to conceive. From ovulation tracking to preconception and prenatal appointments to discuss nutrition and lifestyle choices, many prospective parents work hard to create the optimal foundation to increase their chances of conception. However, there is one foundational nutrient that deserves special attention well before you see two lines on a pregnancy test, and that is folate. 

Folate is essential for making DNA, supporting cell division, preventing neural tube defects, lowering the risk of complications once someone does become pregnant, and even helps with postpartum depression. The role of folate can become especially important in the early weeks of pregnancy, when rapid cell growth is happening and the neural tube — the hollow structure in early embryos that eventually becomes the baby’s central nervous system — forms. Because neural tube development often occurs before a person even knows they are pregnant, preconception folate intake can be essential. 

Still, it is important to understand that “folate” is a broad term. There are different types of folate, and understanding them can make preconception and prenatal nutrition and preparing for pregnancy less confusing. 

The different forms of folate

Folate is more commonly known as vitamin B9, a nutrient that is naturally found in foods like leafy greens, beans, citrus fruits, avocado, and fortified grains. It works with the body to help carry out one-carbon metabolism, a series of biochemical processes that are involved in DNA synthesis, amino acid metabolic processes, and normal cell growth — all of which are key foundations for a healthy pregnancy.

Folate can appear in different forms, including: 

• Folic acid: A stable, synthetic form of folate that is used in many supplements and fortified foods. 
• Folinic acid: This is a reduced or activated form of folate sometimes added to specialized supplements. This form still requires metabolic conversion steps before becoming a completely bioactive form of folate.
• L-methylfolate: This is the precise and most active form of folate that the body can immediately use directly in methylation and cellular processes. 

While all three forms are often discussed together under the umbrella term “folate,” they are distinctive in the way the body uses them. This distinction can be an important factor in choosing the form of folate for preconception and prenatal nutrition planning.

What women should know about MTHFR and folate metabolism 

Conversations about folate can often revolve around the MTHFR gene. This gene provides instructions for an enzyme that is involved in converting folate into 5-MTHF, or L-methylfolate. Common genetic variants can affect the efficiency of methylation, including DHFR and MTHFR genes that affect how the body processes folate. 

For some people, the existence of the MTHFR gene and variants that can impact the methylation process raises a reasonable question: If the body has to convert folic acid or folinic acid into an active form of folate before it can be properly used by the body, wouldn’t it make the most sense to start with L-methylfolate, which is already the most active form of folate? Since L-methylfolate is already in its most active form, it does not rely on the MTHFR enzyme for that particular conversion step. 

Questions like these can be productive when you meet with your healthcare provider, especially if you are aware that you have an MTHFR variant that can make methylation challenging. 

A practical pre-conception approach 

If you are hoping for a pregnancy in the near future, it can help to start a preconception conversation with your medical provider. Ask about what amount of folate may be right for preconception purposes, talk about your health history, and if you are aware of whether you have an MTHFR gene mutation or other nutrient-related concerns such as anemia. Take a look at your current preconception and prenatal vitamins to determine if they provide enough of the right nutrient forms (the most bioavailable types for optimal absorption), and consider whether L-methylfolate is a better option for your needs. 

Folate is a small nutrient, but it plays a significant role in the earliest stages of development. Staying consistent with the correct form of folate for your individual needs can be an important, informed step toward preparing for pregnancy. 

Through informed planning, careful label consideration, and collaborative conversations with your doctor, you can lay a strong foundation for your future pregnancy. 

ABOUT THE AUTHOR

Jamie Hope is the founder of Methyl-Life®, a company dedicated to providing targeted nutritional solutions for individuals with genetic health challenges. With a BA in Education and postgraduate work in Technology, Jamie spent over two decades building a successful career in the high-tech industry before a personal health crisis forced them to step away. Through their own journey, Jamie discovered that their condition was linked to genetic factors requiring specialized nutrients, and after experiencing significant recovery, Jamie was inspired to help others facing similar struggles. Jamie launched Methyl-Life® to make these life-changing nutrients more accessible, and today, they are passionate about guiding individuals through the often confusing landscape of genetics and health, empowering others to improve their own well-being with effective, science-informed solutions

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Cover image by Lisa Fotios