Pregnancy can take a huge toll on your body (that little baby is taking up a lot of your energy to grow!) and one of the things that can happen during those nine months is becoming deficient in certain nutrients and vitamins.
This isn’t typically something to worry about and there are pretty easy fixes to make sure you’re getting all of those vitamins and minerals that you (and your baby) need.
One of the vitamins that is vital during those first few weeks (literally — we're talking the first one to four weeks, but more on that later) is folate.
Folate is responsible for the very early development of your baby so is something (nearly — there are a few exceptions) every expectant mother should take.
Read on to get all of the insight into exactly what folate is, signs of folate deficiency, why it’s so important during pregnancy and everything you need to know about folate supplementation.
What is folate?
Folate is a form of vitamin B9 and is naturally found in a lot of foods. There is also a synthetic version of folate called folic acid, which is added to food and supplements.
We know, it can be a little confusing! There are actually a few forms of vitamin B9, which include folic acid, folinic acid and methylfolate.
Folate is naturally occurring in foods like leafy green vegetables, beans, whole grains, seafood and fresh fruit.
Unlike folate, folic acid doesn’t occur naturally. It's used for food fortification and is commonly added to bread, pasta, rice and breakfast cereals in the US and all bread-making flour (except for organic) in Australia. It's also used for supplements.
Folate helps your body build healthy red blood cells. If you’re pregnant, it’s especially important to help your baby develop those cells — more on that to come.
What is folate deficiency?
A folate deficiency — also known as folate deficiency anaemia — occurs when a lack of folate in the body causes anaemia, which means you have too few red blood cells.
It’s not common to have a folate deficiency if you have a well-balanced diet, but there are some who are more prone to it than others, including pregnant people — more on that to come.
Symptoms of folate deficiency
There are a variety of symptoms of folate deficiency, the most common being extreme tiredness and a lack of energy. Other symptoms of folate deficiency include:
- Mouth sores and ulcers
- Weight loss
- Reduced sense of taste and smell
- Headache and dizziness
If left untreated, you may develop folate deficiency anaemia, which can lead to complications.
Causes of folate deficiency
It's actually not super common to have a folate deficiency thankfully, and it mostly presents in those aged 65 and over. There are a few things that can cause folate deficiency in everyday life, though.
The folate your body naturally produces only lasts around four weeks, which is why it’s so important to supplement it through your diet.
And, in general, a folate deficiency is largely caused by not having a balanced diet that includes lots of leafy green vegetables (think: spinach, asparagus, broccoli), fresh fruit, whole grains and eggs.
Malabsorption conditions such as inflammatory bowel disease, coeliac disease, and pancreatitis can interfere with the absorption of nutrients leading to a folate deficiency.
Certain types of cancer can cause the body’s need for folate to increase, leading to a deficiency.
You can be at greater risk if you have a high alcohol intake or have alcoholism. This is because the digestive system can become damaged and can impair the absorption of nutrients.
It also increases the amount of folate excreted in urine due to changes in liver function. A 2011 study suggests that up to 80 per cent of people with alcoholism can have a folate deficiency.
During pregnancy, you can become deficient because your body is working overtime so you need more than your usual amount. Your body is working to create a whole human, after all!
Most pregnancy supplements contain folic acid as the key ingredient, however, studies have shown that roughly one in three people struggle to convert folic acid due to a common gene variant (the MTHFR-gene).
What happens if you are deficient in folate?
If you have a folate deficiency, you can experience one or multiple of the symptoms listed above, which can make daily life a challenge. If these symptoms go untreated, they can cause further health problems.
However, many of these are easily treated with a visit to your doctor to get advice on your specific circumstances and how much folate you should take to combat the deficiency.
A folate deficiency can also lead to folate deficiency anaemia, which can cause a whole host of other symptoms as your body's red blood cells are unable to function properly.
Folate is incredibly important during pregnancy to ensure the proper development of the foetus and the health of the mother.
Why is folate important for pregnancy?
As previously mentioned, folate has been proven to be incredibly important during the early stages of pregnancy. It’s been widely proven and recommended to take folate during pregnancy to help form the neural tube.
The first studies started in the 1960s, with results published in the 1980s, showing significant enough evidence between folic acid and supporting a healthy pregnancy. Since the '90s, it's been recommended that pregnant people take folate or folic acid supplements.
So, why is it crucial? Folate in pregnancy helps prevent birth defects that affect the baby’s brain (anencephaly) and spine (spina bifida). A neural tube defect can cause serious damage and in some cases, also lead to death.
The neural tube develops very early during pregnancy, closing around four weeks after conception — before most people realise they are pregnant. This is why it’s recommended to take the supplement for around three months before trying to conceive.
How much folate is needed during pregnancy?
The typical recommended amount for pregnant women (or those trying to conceive) is 400 micrograms (0.4mg), according to the Australian Dietary Guidelines.
You may also be advised to take a higher dose of folic acid than normal, which may be the case if:
- You’ve previously been affected by a neural tube defect
- You or the baby’s biological father has neural tube defects or have a family history of it
- You have diabetes
- You have a malabsorption issue (for example, inflammatory bowel disease)
- You take medication for epilepsy
- You take certain medications that can interfere with folate (for example, sulfonamides or methotrexate — you can ask your doctor for advice on this)
You should always seek advice from your GP to make sure you’re getting the correct dose of folate for your circumstances.
Can low folate be dangerous?
Low folate levels and a folate deficiency can lead to complications for everyone, though this is rare. However, pregnant people are at risk of complications caused by low folate levels.
As discussed, it can cause serious birth defects during early pregnancy (typically four weeks after conception).
Low folate can also cause issues during birth and premature birth. In fact, higher folate levels in the mother were associated with a 28 per cent reduction in the risk of premature birth.
Severe anaemia (regardless of the cause, including folate deficiency anaemia) can cause complications.
In some cases, folate deficiency anaemia can lead to heart and lung complications, as well as neurological symptoms, like memory loss, vision problems and pins and needles, which can become irreversible.
Severe complications include being at risk of developing heart failure. However, in the majority of cases, low folate and anaemia have straightforward treatments and avoiding long-lasting complications is possible.
What's the best way to consume folate?
It’s always important to make sure you’re consuming a well-balanced diet to avoid various deficiencies, folate being one of them.
However, not everyone can get their recommended intake of folate through diet alone, particularly pregnant people.
If you’re pregnant, it’s recommended that you take 400 micrograms of folate every day.
Ideally, you should start supplementation prior to conceiving but you can also start taking a supplement as soon as you discover you're pregnant.
Who shouldn’t take folic acid?
Although folic acid is recommended to most mothers, there are a few people who shouldn’t take it (your doctor can help guide you if you’re unsure).
The main people who should avoid folic acid (or who should consult their doctor first) are:
- Those who have ever had an allergic reaction to folic acid
- Those who have cancer (though this really varies so absolutely take the advice from your doctor)
- Those who have low vitamin B12 levels.
Are folate and B12 the same thing?
Both vitamin B12 and folate are important for your body's ability to carry red blood cells, and both can cause the symptoms above, but they are not the same thing.
They do, however, work together to make these cells and iron work correctly in the body.
Folate and vitamin B12 work together to produce something called S-adenosylmethionine (SAMe), which is naturally occurring in the body.
This helps to produce and regulate hormone function as well as maintain cell membranes.
Difference between vitamin B12 deficiency and folate deficiency?
B12 deficiency symptoms tend to develop at a slower rate than folate, sometimes over years.
This is because your body stores B12 for two to five years, whereas folate for only four months, leading to folate deficiency quicker. 'You may also experience neurological symptoms such as problems with your vision, coordination and memory loss — with or without anaemia.
Pernicious anaemia (an autoimmune condition affecting the stomach and its ability to absorb vitamin B12) is one of the most common causes of vitamin B12 deficiency.
Vitamin B12 is found in meat and dairy products and eggs, unlike folate which is found in plant foods.
The main symptoms of folate deficiency are fatigue, muscle weakness and many others listed above.
If you are deficient in folate, you will likely notice it within weeks or months. Folate deficiency anemia can present with these symptoms, plus classic anaemia symptoms that include impaired cognitive function.
Both deficiencies can be diagnosed with a blood test. A low level of either B12 or folate indicates a deficiency.
How is folate deficiency treated?
The good news is that it’s relatively straightforward to get your folate levels regulated again if you have a folate deficiency.
Upon consultation with your doctor, you will most likely be instructed to take a folate or folic acid supplement, while also trying to increase your intake of folate through foods like green leafy vegetables.
If you're unsure of what supplement is best for you, be sure to consult your doctor.