The amount of folates – group B vitamins – that we obtain through food may be sufficient for the general population, but the requirements of this micronutrient increase during pregnancy and it is necessary for pregnant women to take a supplement of 400 micrograms of folic acid. (and not other forms of folate) to prevent birth defects such as neural tube defects.
A recent investigation carried out by the Department of Pharmaceutical and Health Sciences of the San Pablo-CEU University of Spain, in collaboration with the pharmaceutical company Italfarmaco, on the scientific evidence of folic acid (FA) and other forms of folate, such as 5-MTHF, during pregnancy has compiled clinical evidence and other characteristics of folic acid compared to other forms of folate. Their results have been published in the scientific journal Nutrients.
Despite the importance of including sufficient amounts of folic acid in the diet, especially during periods of rapid cell division and growth, as occurs during the development of the fetus, data from ANIBES (Anthropometry, Intake and Energy Balance Study in Spain), A representative study of the Spanish population showed an average folic acid consumption of 156.3 μg/day. Thus, the proportion of adequacy for folates in the total population of women was only 3% (percentage of women with folic acid consumption greater than 80% of the daily reference intake).
The authors conclude that “there is a clear need to improve folate intake in the Spanish population.” Other studies have demonstrated similar findings: for example, a national survey of the German population showed a mean folate intake of 200 μg/day.
Supported by international studies, the article analyzes four key aspects:
- Structure, metabolism and bioavailability of folates.
- Clinical evidence for dietary folates, folic acid, and 5-MTHF.
- Effect of genetic profile on the efficacy of folic acid (MTHFR enzyme polymorphism).
- Safety of dietary folate, folic acid, and 5-MTHF consumption.
The article begins with a brief explanation of the structure, metabolism, and supplementation of folic acid and other forms of folate. In addition, intake recommendations are presented according to various scientific societies for stages such as pregnancy and lactation.
The comparative analysis between folic acid and 5-MTHF is divided into several sections. First, the structural differences between both molecules are examined, and then studies are compiled that compare their bioavailability and their role in the prevention of neural tube defects (NTDs). As a main conclusion, it is noted that, so far, only folic acid has solid clinical evidence in the prevention of neural tube defects in pregnancy.
To date, only folic acid has solid clinical evidence in the prevention of neural tube defects in pregnancy.
A positive relationship is also highlighted between folic acid supplementation during pregnancy and the reduction of other malformations, such as congenital heart defects, cleft lip, palate and urinary tract defects. It is important to mention that there is currently no strong evidence to support the potential benefits of 5-MTHF in preventing these conditions.
Folic acid supplementation, effective in women with variations in the MTHFR gene
Another aspect that is analyzed is how genetic variations can influence the effectiveness of folic acid, in particular the impact of polymorphisms of the MTHFR enzyme. The authors conclude that a supplementation of 400 μg of folic acid is effective in reducing neural tube defects, regardless of variations in the MTHFR gene.
Finally, the safety of folic acid is reviewed, highlighting that it is a water-soluble molecule that rarely produces toxicity, since the excess is usually eliminated through urine.
Overall, this article provides value essentially because:
- It clearly explains the structural differences between folic acid and 5-MTHF, and how only folic acid is used in medications and fortified foods.
- It demonstrates that folic acid is the only molecule with clinical studies supporting its use in preventing NTD in pregnancy.
- Highlights other benefits associated with folic acid supplementation during pregnancy, beyond the prevention of NTD.
- It notes that supplementation with 400 μg of folic acid is effective in preventing NTD in all women, including those with MTHFR genetic variants.
- It confirms that folic acid is a water-soluble vitamin and does not accumulate in the body, which guarantees its safety.
- It concludes that, to date, there is no solid evidence on the benefits and safety of 5-MTHF, and that more rigorous studies are needed to recommend its supplementation.
In summary, this study provides additional evidence supporting the value and scientific rationale for using folic acid in products such as Natalben Supra, and medications such as Yodocefol, Acfol and Folidoce to promote optimal child development. This updated compilation of scientific evidence and recommendations could serve to raise awareness about the importance of folic acid intake during pregnancy and debunk some of the existing myths about folic acid that circulate on social networks.
A notable achievement of this publication is that the CDC (Centers for Disease Control and Prevention), an organization of great international prestige, has shown interest in this review, especially in the figure that compares the evidence between folic acid and 5 -MTHF.
