folic acid vs folinic acid
Penny cited the following
7 peer-reviewed research articles
3 professionally-backed sources
1 article from a healthcare institution
Overview
Folic acid and folinic acid are both forms of vitamin B9, but they are not the same. Folic acid is the synthetic form most commonly recommended and proven to prevent neural tube defects (NTDs) in pregnancy. Folinic acid (also called 5-formyl tetrahydrofolate or leucovorin) is a different, active form of folate sometimes used in specific medical situations, but it is not the standard for NTD prevention in pregnancy.
Key Points: Folic Acid vs Folinic Acid
What is Folic Acid?
- Folic acid is the synthetic form of folate (vitamin B9) found in supplements and fortified foods.
- It is the only form that has been clearly shown in large studies to prevent neural tube defects (NTDs), which are serious birth defects of the brain and spine, when taken before conception and in early pregnancy.
-
The standard recommendation is 400 micrograms (mcg) of folic acid daily for anyone who could become pregnant, starting at least one month before conception and continuing through the first trimester. Higher doses may be recommended for those with a history of NTDs or certain risk factors.
1ArticleAbout Folic Acid | Folic Acid | CDCFolic acid is especially important during early pregnancy, because it helps the neural tube—which becomes the brain and spine—develop. It is the only form of folate that's been shown to help prevent serious birth defects called neural tube defects (NTDs).→
Centers for Disease Control and Prevention
2ArticlePregnancy, breastfeeding and fertility while taking folic acid - NHSNHS medicines information on folic acid and whether you can take it while pregnant or breastfeeding.→nhs.uk
3ArticleFolic Acid for a Healthy Baby | Johns Hopkins MedicineThe developing baby needs folate to make healthy new cells, and to make DNA and RNA (genetic material). These are cell-building blocks. Folate also is essential to form normal red blood cells and certain amino acids. These are important functions during pregnancy and infancy.→Johns Hopkins Medicine
4ArticleFolic Acid: Facts for Clinicians | Folic Acid | CDCMany studies have shown that taking folic acid before and during pregnancy can help lower the chance of neural tube defects.1 Getting 400 micrograms (mcg) of folic acid daily can help prevent neural tube defects (NTDs).→5ArticleFolic Acid for the Prevention of Neural Tube Defects | Pediatrics | American Academy of PediatricsThe American Academy of Pediatrics endorses the US Public Health Service (USPHS) recommendation that all women capable of becoming pregnant consume 400 μg of folicacid daily to prevent neuraltubedefects (NTDs). Studies have demonstrated that periconceptional folicacid supplementation can ...→American Academy of Pediatrics Publications
6ArticleIntroduction - Folic Acid Supplementation to Prevent Neural Tube Defects: A Limited Systematic Review Update for the U.S. Preventive Services Task Force - NCBI BookshelfHigh levels of folic acid supplementation (4 mg) have been found to reduce the risk of recurrent NTDs by more than 70 percent, and even more modest levels of folic acid supplementation (0.4 mg) reduce the first occurrence of NTDs.22 The mechanism by which folate reduces the risk of NTDs is ...→National Center for Biotechnology Information
-
Folic acid is more stable than natural food folates and is well absorbed by the body.
3ArticleFolic Acid for a Healthy Baby | Johns Hopkins MedicineThe developing baby needs folate to make healthy new cells, and to make DNA and RNA (genetic material). These are cell-building blocks. Folate also is essential to form normal red blood cells and certain amino acids. These are important functions during pregnancy and infancy.→4ArticleFolic Acid: Facts for Clinicians | Folic Acid | CDCMany studies have shown that taking folic acid before and during pregnancy can help lower the chance of neural tube defects.1 Getting 400 micrograms (mcg) of folic acid daily can help prevent neural tube defects (NTDs).→
What is Folinic Acid?
- Folinic acid (5-formyl tetrahydrofolate, leucovorin) is an active form of folate used in certain medical situations, such as to reduce side effects of specific chemotherapy drugs or to treat folate deficiency in people who cannot properly metabolize folic acid.
-
Folinic acid can be used during pregnancy if needed, and there is no known risk of fetal harm. However, it is not the standard supplement for NTD prevention.
7ArticleFolinic Acid - StatPearls - NCBI BookshelfPregnant women: Folinic acid/leucovorin may be used during pregnancy; human data shows no known risk of fetal harm.→8ArticleEfficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial - PubMedIn conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental ...→
PubMed
-
Folinic acid is sometimes marketed as a more "bioavailable" form of folate, but there is no strong evidence that it is superior to folic acid for preventing NTDs in the general population.
9ArticlePrevention of Neural Tube Defects and proper folate periconceptional supplementation - PMCDaily cost of folicacid use varies from Euro 0.05 (Folico tablets) to 0.12 (Folidex, Fertifol, Folina tablets), while daily cost of folinicacid is four to ninefold higher (Euro 0.30-0.45). The use of folinicacid (calcium levofolinate) in preventing NTDs is inappropriate. 1.MRC Vitamin Study Research Group. Prevention of neuraltubedefects...→
PubMed Central
Effectiveness for Neural Tube Defect Prevention
-
Only folic acid (not folinic acid) has been proven in large, well-controlled studies to prevent neural tube defects when taken before and during early pregnancy.
1ArticleAbout Folic Acid | Folic Acid | CDCFolic acid is especially important during early pregnancy, because it helps the neural tube—which becomes the brain and spine—develop. It is the only form of folate that's been shown to help prevent serious birth defects called neural tube defects (NTDs).→5ArticleFolic Acid for the Prevention of Neural Tube Defects | Pediatrics | American Academy of PediatricsThe American Academy of Pediatrics endorses the US Public Health Service (USPHS) recommendation that all women capable of becoming pregnant consume 400 μg of folicacid daily to prevent neuraltubedefects (NTDs). Studies have demonstrated that periconceptional folicacid supplementation can ...→6ArticleIntroduction - Folic Acid Supplementation to Prevent Neural Tube Defects: A Limited Systematic Review Update for the U.S. Preventive Services Task Force - NCBI BookshelfHigh levels of folic acid supplementation (4 mg) have been found to reduce the risk of recurrent NTDs by more than 70 percent, and even more modest levels of folic acid supplementation (0.4 mg) reduce the first occurrence of NTDs.22 The mechanism by which folate reduces the risk of NTDs is ...→9ArticlePrevention of Neural Tube Defects and proper folate periconceptional supplementation - PMCDaily cost of folicacid use varies from Euro 0.05 (Folico tablets) to 0.12 (Folidex, Fertifol, Folina tablets), while daily cost of folinicacid is four to ninefold higher (Euro 0.30-0.45). The use of folinicacid (calcium levofolinate) in preventing NTDs is inappropriate. 1.MRC Vitamin Study Research Group. Prevention of neuraltubedefects...→
-
Folinic acid is not considered an equivalent substitute for folic acid in this context, and using it instead of folic acid for NTD prevention is not recommended by major guidelines.
9ArticlePrevention of Neural Tube Defects and proper folate periconceptional supplementation - PMCDaily cost of folicacid use varies from Euro 0.05 (Folico tablets) to 0.12 (Folidex, Fertifol, Folina tablets), while daily cost of folinicacid is four to ninefold higher (Euro 0.30-0.45). The use of folinicacid (calcium levofolinate) in preventing NTDs is inappropriate. 1.MRC Vitamin Study Research Group. Prevention of neuraltubedefects...→
Special Circumstances
-
People with certain genetic mutations (such as MTHFR mutations) may have trouble converting folic acid to its active form. There is some discussion about whether these individuals might benefit from other forms of folate (like l-methylfolate or folinic acid), but current evidence is not strong enough to change standard recommendations for most people.
10ArticleFolic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention - PMCFolate (vitamin B9) is an essential nutrient that is required for DNA replication and as a substrate for a range of enzymatic reactions involved in amino acid synthesis and vitamin metabolism. Demands for folate increase during pregnancy because it ...→11ArticleFolic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention - PMCFolate (vitamin B[9] ) is an essential nutrient that is required for DNA replication and as a substrate for a range of enzymatic reactions involved in amino acid synthesis and vitamin metabolism. Demands for folate increase during pregnancy because it ...→
-
Folinic acid may be used in combination with iron for treating iron deficiency anemia in pregnancy, but this is a different indication than NTD prevention.
8ArticleEfficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial - PubMedIn conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental ...→
Summary
Folic acid is the only form of vitamin B9 that has been clearly shown to prevent neural tube defects when taken before and during early pregnancy. Folinic acid is an active form of folate used in specific medical situations but is not recommended as a substitute for folic acid for NTD prevention. For most people, taking 400 mcg of folic acid daily before and during early pregnancy is the best-supported way to reduce the risk of serious birth defects of the brain and spine. If you have a specific medical condition or genetic concern, you might want to discuss your options with your OB/GYN or a healthcare provider who can work with you based on your specific medical history.