By Alan Vu, Naturopathic Doctor

This is a particularly difficult time for everyone, but my heart really breaks for those who have had their dreams of starting a family put on hold.  Even if temporarily.

It is not my intention to make light of the situation or find a silver lining, but I do want to share some tips about preconception nutrition and health that may be useful in this waiting period.

There are many areas of preconception health that can be addressed to improve pregnancy outcomes.  These include optimizing physical activity, improving blood sugar regulation for those with diabetes or prediabetes, optimizing critical nutrients levels such as iron, vitamin D, and more. Each one of these things can independently support better pregnancy outcomes. 

Today’s topic is Part One in our preconception health series that Zeynep and I will be putting out over the coming weeks. 

I want to start by talking about the most important nutrient for pregnancy outcomes: folate.

Folate in preconception

A quick note: folate and folic acid are often used interchangeably, but they are not exactly the same. Folate is the natural form of this nutrient (vitamin B9), found naturally in foods (leafy greens, beans, peas and lentils). Folic acid is the synthetic form. Many processed grains in North America are fortified with folic acid, and most supplements including prenatal vitamins have folic acid.

Folate plays a critical role in many metabolic processes, and that is why it is so critical in early pregnancy, when rapid fetal growth is happening. Getting adequate blood folate levels helps the fetal development of the baby, and prevents congenital malformations such as neural tube defects. 

In addition, it is beneficial for fertility too. Most of the research on this vitamin and fertility has so far been done with folic acid. One very large study of nurses showed that those who consumed the most folic acid had the lowest rates of difficulty ovulating (1). In women undergoing IVF, those with the highest amount of folic acid intake (more than 800ug/day) had higher pregnancy and live birth rates (2, 3)

So what does this mean?

Get lots of folate from food sources. Make sure your prenatal vitamin has at least 1mg of folate, ideally in the form of active folate (you’ll see it on the label as “5-MTHF”). Don’t stress if the prenatal you have is folic acid instead of folate.

In addition, there are some special populations of individuals who are advised to take higher quantities of folate. This is something that your family doctor, fertility doctor or naturopath can advise.  Too much folic acid can also be harmful. 

Here is what we’re recommending to patients:

  • Get sufficient folate from your prenatal vitamin – check to make sure it contains at least 1 mg (folic acid or folate/5-MTHF).
  • Get plenty of additional folate from food sources
  • You may need to supplement with additional folate if you are on a grain-free diet and you don’t quite get enough folate from other foods (some people who follow the ketogenic diet may fall into this category).
  • Any supplement with folic acid should also contain vitamin B12
  • Ideally, in order to reach sufficient levels of folate, it is best to take folate for 2-3 months leading up to pregnancy

In summary, folate is the most important vitamin for fertility and pregnancy outcomes.  Check your prenatal vitamin today to make sure you are getting enough.


1 Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2008). Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertility and Sterility, 89(3), 668–676

2 Gaskins AJ, Afeiche MC, Wright DL, et al. Dietary folate and reproductive success among women undergoing assisted reproduction. Obstet Gynecol. 2014; 124:801–9. [PubMed: 25198264] 21.

3 Gaskins AJ, Chiu YH, Williams PL, et al. Association between serum folate and vitamin B-12 and outcomes of assisted reproductive technologies. Am J Clin Nutr. 2015; 102:943–50.


About the Author

Alan Vu ND
Alan is a Licensed Naturopath as well as a Clinical and Academic Adjunct Faculty Member at the Canadian College of Naturopathic Medicine. He is also a member of both the Canadian and Ontario Associations of Naturopathic Doctors and the Canadian Fertility & Andrology Society.