Folate and Choline Before Pregnancy: What the Guidelines Set
Folate is the nutrient almost everyone trying to conceive has heard of. Choline is the one almost nobody has, and prenatal supplements tend to contain very little of it.
The numbers on this page are the intakes health authorities publish. We are reporting what they say, not telling you what to take. Any decision about supplements belongs with your own clinician, who knows your history.
What does folate actually do?
It builds and repairs DNA. That matters most where cells are dividing fastest, which is exactly what an early pregnancy is.
Folate is involved in making and repairing DNA and is crucial for cell division, which matters most before pregnancy and early in pregnancy.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
"Folate functions as a coenzyme or cosubstrate in single-carbon transfers in the synthesis of nucleic acids (DNA and RNA)"; methylation "required for proper cell division"; pregnancy "demands for folate increase because of its role in nucleic acid synthesis."
Folate transfers single-carbon units between compounds and is vital for building DNA and interconverting amino acids.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
Folate functions as a coenzyme or cosubstrate in single-carbon transfers in the synthesis of nucleic acids (DNA and RNA) and metabolism of amino acids [1-3].
The published figures are below. They are stated in DFE, or dietary folate equivalents, which is a unit that exists precisely because the next question on this page is unavoidable.
Pregnant women should consume 600 mcg DFE of folate per day, dropping to 500 mcg per day when breastfeeding.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
individuals who are pregnant should consume 600 mcg DFE daily, and individuals who are breastfeeding should consume 500 mcg DFE daily.
Why do folic acid and food folate count differently?
Because your body absorbs them differently, and by roughly a factor of two. This is the reason a label's milligram number and a guideline's DFE number are not the same quantity, and it is where most of the confusion about folate lives.
It also has a reassuring consequence, which is the next point.
Folic acid in supplements has twice the bioavailability of food folate: 1 mcg natural folate = 1 mcg DFE, while 1 mcg supplemental folic acid = 2 mcg DFE.
Supported by a systematic review
Clinical review pending
A systematic review of the research supports this.
folate derived from fortified foods or from supplements was either 1.7 (85/50) or 2.0 (100/50) times, respectively, as bioavailable as naturally occurring food folate.
Natural (non-methylated, food-sourced) folate has lower bioavailability than other supplement forms.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
"only about 50% of folate naturally present in food is bioavailable" vs "at least 85% of folic acid is estimated to be bioavailable when taken with food" and 5-MTHF bioavailability "the same as or greater than that of folic acid."
It is nearly impossible to consume too much folate from food alone.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
"The FNB did not establish a UL for folate from food because high intakes of folate from food sources have not been reported to cause adverse effects."
Ordinary ones, which is a nicer answer than the supplement aisle suggests.
Leafy greens, legumes, beef liver, eggs, citrus, and fortified foods are high in folate.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
Folate is naturally present in a wide variety of foods, including vegetables (especially dark green leafy vegetables), fruits and fruit juices, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry, and grains. Spinach, liver, asparagus, and brussels sprouts are among the foods with the highest folate levels.
Good question, and the honest answer is that it is under-discussed rather than newly discovered. Authorities publish intakes for it, and most prenatal supplements do not come close to them, so it is one of the few nutrients where food does the heavy lifting by default.
Choline maintains cell structural integrity and creates a neurotransmitter supporting memory, mood, muscle control, and other brain and nervous system functions.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
"all plant and animal cells need choline to preserve their structural integrity"; "acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions."
Prenatal supplements usually contain only a small amount of choline, so most choline must come from food, and a choline supplement should be discussed with a doctor if 450 mg/day is unachievable.
Supported by a systematic review
Clinical review pending
A systematic review of the research supports this.
The reference values for pregnant and lactating women are 450 mg/d and 550 mg/d... the majority of young women consume approximately 300 mg/d of choline... the AMA report implicates that adding 50 mg/d of choline is not sufficient... adding up to 250 mg of choline to maternal multivitamin supplements
The richest choline amounts are in animal products (beef liver, egg yolk, chicken, fish), with a broader list of choline-containing foods.
Stated in a health authority's guidance
Clinical review pending
A health authority states this in its published guidance.
The main dietary sources of choline in the United States consist primarily of animal-based products that are particularly rich in choline—meat, poultry, fish, dairy products, and eggs [4,5,8-10].