Abstract

Folinic acid (leucovorin) supplementation in Folate Receptor Alpha Autoantibody (FRAA)-positive pregnancies offers a biologically targeted strategy to reduce Autism Spectrum Disorder (ASD) risk and is proving superior to folic acid across a broader range of reproductive and neurodevelopmental outcomes. A pilot randomized trial by Giorlandino et al. together with emerging clinical data on infertility and preclinical evidence on a negative impact of excess folic acid, suggests that leucovorin is the optimal choice of folate form for precision prenatal care. For pregnancies where FRAA is present, standard folic acid supplementation resulted in a majority of the births diagnosed as autistic within three years, while leucovorin supplementation resulted in a 10% autism rate. This striking difference is further evidence of the importance of choosing the appropriate form of folate for perinatal care, with leucovorin proving the safer choice, especially in the presence of FRAA [1-5].