Choosing a Prenatal Multivitamin + Folic Acid vs Folate

Photo Credit to the incredibly talented Abbey from a.frankfilm

First and foremost, we're all doing our best. This blog isn't here to induce guilt—there's already plenty of that around! If you've been taking folic acid during your pregnancy or in your daily multivitamin, please don’t be hard on yourself. We are all learning and we can only do better when we know better.

Choosing the Best Prenatal Vitamins for Pregnant Mumma's

As a holistic pregnant mum, ensuring you get the right nutrients is crucial for both you and your baby. High-quality prenatal multivitamins are specifically formulated to support your nutritional needs during pregnancy and help replenish your stores after giving birth. It’s recommended to take a multivitamin throughout your entire pregnancy and continue while breastfeeding. There are some general recommendations that @littleandnourished notes inside the @nurturedbeginningsonline Holistic Pregnancy Course. This blog contains general advice, for individual advice, please refer to a Naturopath, Nutritionist, or Functional/Integrative GP for the best option for you!

Supplement, Don't Replace

Prenatal vitamins should supplement your diet, not replace nutrient-rich foods. Look for a high-quality prenatal multivitamin that covers most of your nutritional requirements for water-soluble vitamins and minerals without unnecessary fillers. If your diet or prenatal multivitamin doesn't meet your daily nutrient needs, additional supplementation may be necessary.

Quality Ingredients

1. Whole Foods: Choose multivitamins sourced from 100% organic, whole foods, including various vegetables, fruits, and herbs (or opt for an herb-free formula if preferred).
2. High-Quality Synthetic Nutrients: Ensure that the synthetic nutrients are of high quality.

We (Bree and Aroha) love for Foraged for you as it ticks all of these boxes. Bree was smashing foraged throughout Pregnancy and Postpartum particularly with her twin birth and breastfeeding journeys.

Prenatal Vitamins Are Unregulated

There are no FDA requirements that define the use of the word "prenatal" on multivitamins or any supplementation. Some supplements marketed as “prenatal” may even contain ingredients that are contraindicated during pregnancy. It’s important to choose supplements carefully and ensure they meet your needs.

Choosing Natural Sources

Check your supplements and aim to get your folate from food. If you need to supplement, opt for forms like folic acid or 5-MTHF, which the body can utilise more effectively than folic acid. Although folic acid is cheaper, it’s worth investing in supplements that your body can properly metabolise.

Inside the @nurturedbeginningsonline Holistic pregnancy Course we walk you through foods High in Natural Folate and have recipes that include these options. Think along the lines of Asparagus, Leafy greens, Broccoli, Beetroot, Brussels sprouts, Liver and Legumes for natural folate as your standard wholefoods.

It’s ideal to take prenatal vitamins all throughout pregnancy, as well as before and after, during preconception and postpartum. Ensuring you take the right prenatal vitamins can make a significant difference in your pregnancy journey. By choosing high-quality supplements and focusing on natural, whole food sources, you can support your and your baby’s health holistically.

Folate vs. Folic Acid

While "folate" and "folic acid" are often used interchangeably, they are not the same. Folate is a general term that includes compounds like folic acid, folinic acid, and 5-MTHF, all known for preventing neural tube defects. Folic acid is a synthetic form found in some supplements and fortified foods, requiring several reactions and catalysts to be activated in the body, which can reduce its effectiveness. Folic acid is also found in breads, and cereals so out ‘load’ of folic acid can increase quite dramatically if we aren’t mindful. In contrast, folinic acid and 5-MTHF occur naturally in foods and are already "activated," making them easier for the body to absorb and use. 

Many of us trust that the vitamins and minerals in our supplements and foods are beneficial. Unfortunately, not all of them are. Elevit (a common off the shelf prental) contains the synthetic form, folic acid.

Around 40% of people have a genetic variation that affects the enzyme needed to convert synthetic folic acid into its active form, usable folate. This variation can hinder the body's ability to process synthetic folic acid effectively, potentially leading to a buildup of unmetabolised folic acid and a deficiency in natural folate.This deficiency can cause the very issues we are trying to prevent, such as birth defects and neurological problems. Synthetic folic acid can also mask symptoms of vitamin B12 deficiency, leading to further health complications.

If you aren't sure if you carry the genetic variation here is a link to test for MTHFR Genetic Testing. We suggest seeking individualised support specific for you post this testing by a nutritionist, functional GP or naturopath.

Studies have also linked high intake of folic acid to impaired neurological development, including autism. Excessive intake of any vitamin can disrupt metabolic activities. The safe upper limit for folic acid is suggested to be 1000 mcg per day, a level often found in prenatal vitamins alone. Add to that the folic acid in fortified foods, and it’s easy to exceed this limit. 

A deficiency in natural folate can lead to:

• Midline birth defects (e.g spina bifida, neural tube defects, tongue ties, cleft palate, cleft lip)
• Premature birth
• Weakness and fatigue
• Anxiety
• Neurological development problems
• Miscarriages

Why we Personally Wouldn't Choose Elevit or a Standard Off-the-Shelf Prenatal with Folic Acid.

Elevit is a low dose, OTC product that does not contain some of the nutrients essential to pregnancy, does contain some that aren’t essential and in forms that may not be the most bioavailable (well absorbed). 

Iron

•   Elevit uses ferrous fumarate as its iron source.
•   A 2013 study found this form to be the least tolerable, often causing gastrointestinal issues like constipation.
•   Iron can aggravate morning sickness, making routine supplementation not recommended at all stages of pregnancy.

B12

•  Elevit contains a less bioavailable form of B12.
• Like folic acid, this form requires extra work for the body to convert into a usable compound.
• B12 is crucial for brain health and neural tube development.

Choline

•  Choline is vital for brain and neural tube development.
• Elevit does not include this essential nutrient.

Vitamin D

•  Pregnant women are recommended to have 1000IU to 2000IU of Vitamin D daily.
• Vitamin D is important for fetal bone development, maternal blood pressure regulation, and the prevention of miscarriage and postnatal depression.
• Elevit provides only 200IU, less than what you'd get from a short walk outside.

Zinc

• Zinc is important for cell and DNA construction, immune system development, and reducing poor maternal outcomes.
• Elevit contains zinc sulfate, a less bioavailable form that can cause gastrointestinal irritation, exacerbating nausea and morning sickness.

Copper

•  Copper is necessary for the formation of red blood cells, the baby's heart, blood vessels, and nervous system.
• While copper levels naturally rise during pregnancy, supplementation might be unnecessary and could lead to zinc deficiency and copper toxicity over time.
• Elevit contains 1mg of copper and a minimal amount of zinc, which could cause this imbalance.

When we know better, we do better. If a non synthetic and bioavailable option for a Prenatal is available - this is your optimal choice. Feel into what feels right for you and always consult your chosen healthcare provider if you are unsure, or reach out to Bree or Aroha for questions or support.

Check out our Holistic Pregnancy Course for only $149 via https://www.nurturedbeginnings.au/store for more education, ritual, recipe cards, guest speakers, meditations, workshops and connection to self tools to support you on your Pregnancy journey.

Resources:

https://www.mamanatural.com/best-prenatal-vitamins/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782876/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793254/

https://www.ncbi.nlm.nih.gov/pubmed/24494987

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704156/ 

https://www.tandfonline.com/doi/full/10.3109/00498254.2013.845705?src=recsys 

https://www.bioceuticals.com.au/education/article/active-folate-versus-folic-acid