What Pregnant Women With PCOS Need to Know About Folic Acid

Pregnant women and women who are trying to conceive hear it all the time: Make sure you take folic acid. Yes, folic acid is important because it can reduce the incidence of birth defects like spina bifida and cleft palate. But for the millions of women (and men) who have a genetic condition that prevents them from being able to use folic acid properly, this advice is harmful and could result in miscarriages and significant health implications for mother and child. Here’s what women with PCOS should know about folic acid.

Pregnant woman
Maa Hoo/Stocksy United

What Is Folic Acid?

Folic acid is a synthetic version of the nutrient folate that is manufactured in laboratories. It is used in multivitamins, prenatal vitamins, and other supplements, and is also used to fortify food. In 1998, a government mandate was created that requires manufacturers of grain products to fortify their flour with folic acid in order to reduce the rates of birth defects.

Common types of foods that have folic acid in them include cereals, pastas, breads, crackers, and other packaged grain foods. You can see the percentage of folic acid listed on a food label. An exception of this rule applies to organic or non-GMO manufacturers who aren’t required to fortify foods with folic acid. Thus, you will typically see low or no amount of folic acid in organic foods.

What Is Folate?

Folate, sometimes referred to as vitamin B9, is a nutrient found naturally in whole foods, such as fruits, vegetables (especially dark leafy ones), beans, and lentils. Folate is a component of red blood cells and has some important roles in the body.

These include being part of DNA and RNA synthesis, ridding the body of toxins and supporting a healthy immune system, converting amino acids, and cell growth. Folate is essential for the development of the central nervous system in embryos, which is why the requirements of folate are higher during pregnancy.

How Much Folate Do I Need?

Adult women need 400 micrograms of folate daily. Those who are pregnant or trying to become pregnant need 600 micrograms daily. These amounts can be difficult to get from food alone.

If you can’t process folic acid, you can easily substitute with a multivitamin or prenatal supplement that contains 5-methyltetrahydrofolate (5-MTHF) or folinic acid, which the body will be able to use properly.

What Happens When You Can’t Metabolize Folate?

Because folate is involved in major processes in the body, not being able to use it can be dangerous and can result in serious long-term health complications (see below). Some people (many who are unaware) have a genetic defect in their ability to use folic acid.

Methylenetetrahydrofolate reductase, or MTHFR, is a genetic condition that affects approximately 10 to 15 percent of Caucasians and more than 25 percent of Hispanic people.

MTHFR is both a gene and enzyme that helps convert folic acid into a usable form of folate. Someone with a variant of MTHFR may not be able to use folate properly.

Health Conditions Associated With MTHFR

While having the MTHFR genetic mutation can affect fertility, it can also result in long-term health issues. Here are some examples of health conditions associated with the inability to use folic acid properly:

  • Depression or post-partum depression
  • Anxiety
  • Infertility
  • Migraines
  • Irritable bowel syndrome
  • Inflammation
  • Blood clots
  • Cancers
  • Chronic fatigue syndrome
  • Inability to detoxify properly
  • Poor immune function
  • Anemia
  • Heart disease
  • Stroke

MTHFR and Infertility

As an enzyme, MTHFR helps to convert the amino acid homocysteine into methionine. This process is important for heart health, detoxification, and for fertility.

If homocysteine doesn’t get converted into methionine, levels of homocysteine levels will build up in the system. High homocysteine levels are linked to recurrent miscarriages as it increases the risk for blood clots in the placenta or fetus.

Not being able to use folate properly can also affect the utilization of other important nutrients such as vitamin B12, coenzyme Q10, and other B vitamins which are important for good egg quality. Many women with PCOS struggle to produce good quality of eggs already because of an imbalance of sex hormones which prevent oocytes from properly maturing.

Ideally, all women who are planning to become pregnant should be screened for the MTHFR mutation prior to conceiving.

How Do I Know If I Have an MTHFR Mutation?

The MTHFR gene can easily be tested. Talk to your healthcare provider to get a blood test for MTHFR. Since there are many different variants of the MTHFR gene mutation, knowing which form you have will determine your treatment course.

Tips to Maximize Your Fertility

If you do have a variant of the MTHFR mutation, there are many changes you can make in your diet to improve your fertility.

Avoid Endocrine Disrupting Chemicals

Commonly found in plastic containers, water bottles, and paper receipts, endocrine-disrupting chemicals (EDCs) can lead to more toxin build-up in your system that can be difficult for your body to remove. Eating more organic foods and drinking filtered water can also help to minimize toxin exposure.

Eat More Fruits and Vegetables

Fruits and vegetables are good sources of folate as are legumes. Some of the highest sources of folate are found in beans, lentils, greens, avocados, asparagus, and broccoli.

Avoid Processed Foods

Processed foods are fortified with folic acid. Avoiding these types of foods will help to lower your exposure to folic acid.

Consider Other Supplements

Talk to your medical professional or healthcare provider about which additional nutritional supplements you may need to take. Common supplements taken by those with the MTHFR mutation include vitamin B12, coenzyme Q10, and other B vitamins.

Having the genetic mutation MTHFR may affect your ability to have a child. Knowing if you have a genetic variant and taking the proper steps to manage it, will help you to have a healthy pregnancy and optimize your health.  

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. NIH Office of Dietary Supplements. Folate.

  3. Dean L. Methylenetetrahydrofolate Reductase Deficiency. In: Medical Genetics Summaries [Internet].

  4. NIH Genetics Home Reference. MTHFR gene.

  5. Anderson S, Panka J, Rakobitsch R, Tyre K, Pulliam K. Anxiety and methylenetetrahydrofolate reductase mutation treated with S-adenosyl methionine and methylated B vitamins. Integr Med (Encinitas). 2016;15(2):48-52.

  6. Dell'edera D, L'episcopia A, Simone F, Lupo MG, Epifania AA, Allegretti A. Methylenetetrahydrofolate reductase gene C677T and A1298C polymorphisms and susceptibility to recurrent pregnancy loss. Biomed Rep. 2018;8(2):172-175. doi:10.3892/br.2018.1039

  7. Zhu Z, Hu Y, Li HW, et al. The implementation and evaluation of HIV symptom management guidelines: A preliminary study in China. Int J Nurs Sci. 2018;5(4):315-321. doi:10.6061/clinics/2015(11)09

  8. NIH MedlinePlus. MTHFR mutation test.

  9. Hormone Health Network. Endocrine-disrupting chemicals EDCs.

Additional Reading
  • Hickey S. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genet Med 2013:15(2):153–156.

  • Thaler CJ. Folate Metabolism and Human Reproduction. Geburtshilfe Frauenheilkd. 2014 Sep;74(9):845-851.

By Angela Grassi, MS, RDN, LDN
 Angela Grassi, MS, RDN, LDN, is the founder of the PCOS Nutrition Center.