I found out years ago after having my first baby that I have an MTHFR variant, and it’s something I’ve kept in mind through every pregnancy since.

MTHFR is one of those topics that gets complicated very quickly. Spend a little time researching it and you’ll find completely different opinions about how much it matters, what supplements you should take, and whether it should change anything about the way a pregnancy is managed.

MTHFR stands for methylenetetrahydrofolate reductase. The gene helps your body make a protein involved in processing folate. The two common variants you’ll hear about most often are C677T and A1298C, and these variants are very common. According to the CDC, more people in the United States have one or two copies of the C677T variant than don’t, so this is incredibly common.

For me, knowing I have MTHFR has made me more proactive. I pay closer attention to certain things, I ask more questions, and I tend to get on top of things very early in pregnancy. I’ve had three babies, including my youngest at 45, and there are four things I’ve consistently done during my three pregnancies.

1. I get my progesterone checked right away

As soon as I get a positive pregnancy test, I call my doctor. I ask to be seen right away and have bloodwork done rather than waiting until the standard first prenatal appointment, which can be as late as 8-12 weeks with some doctors.

One of the first things I ask to have checked is my progesterone. In my pregnancies, I’ve had them check my progesterone levels once or twice a week (during the early weeks) to determine if I needed supplementation (I always have). I’ve also needed supplemental progesterone during the first trimester, so I have always advocated for this and never had a doctor disagree.

Progesterone can provide useful information in certain early-pregnancy evaluations. A 2022 systematic review and meta-analysis of 54 studies, including 15,878 symptomatic first-trimester patients, found that a single progesterone level can provide clinically useful information about pregnancy viability, especially at very low or high levels.

There is also research on progesterone supplementation and miscarriage. The large PRISM trial included more than 4,000 women with bleeding in early pregnancy. Across the full group, the live-birth difference was not statistically significant. In the prespecified subgroup of women with three or more previous miscarriages, 72% of those who received progesterone had a live birth compared with 57% of those who received placebo.

ACOG describes the evidence for progestins in threatened early pregnancy loss as inconclusive overall, while noting that women who have experienced at least three prior pregnancy losses may benefit from progesterone therapy in the first trimester.

NICE in the UK currently recommends vaginal micronized progesterone for women who have a pregnancy confirmed by scan, vaginal bleeding, and at least one previous miscarriage. If a fetal heartbeat is confirmed, its guideline recommends continuing progesterone through 16 completed weeks.

I have had low progesterone and I have needed supplementation. Because of that history, coupled with the miscarriage history in my family, I want to know what my progesterone is doing as early as possible so I make sure to ask for this right away. If a doctor’s office pushes back, I would find a different office.

If you’ve had low progesterone before, previous losses, fertility treatment, early bleeding, or another reason for concern, it’s worth bringing progesterone up with your doctor early and asking what monitoring makes sense for you.

2. I choose methylated prenatal vitamins

This is probably the part of my routine most directly connected to finding out that I have MTHFR.

Because MTHFR is involved in folate metabolism, I started paying much closer attention to the form of folate in my prenatal vitamins. I personally choose prenatal vitamins containing methylfolate (often listed as 5-MTHF) and I tend to look for methylated forms of other B vitamins as well.

I also fully avoid prenatal vitamins that contain folic acid due to my MTHFR status. I would never skip folate because I was worried about taking the wrong form. Adequate folate before conception and in early pregnancy is incredibly important.

If you know you have an MTHFR variant, bring your prenatal vitamin to your doctor and talk about the form and amount of folate you’re getting. Depending on your medical history, you can also ask whether there is any reason to look at B12, folate, or homocysteine.

3. I pay much more attention to environmental toxins

I’m already ingredient-conscious in everyday life, but pregnancy and having children has (as you probably know because you’re reading this) taken it to a whole different level for me. I look at everything from makeup and skincare to shampoo, cleaning products, fragrance, pesticides, plastics, and what I’m using around the house.

Of course, I try to be reasonable because stressing during pregnancy is not helpful, either. You can drive yourself crazy trying to eliminate every questionable chemical from your environment, and pregnancy already gives us plenty to think about. I focus on things I use frequently and exposures that are relatively easy to change.

For personal care products, I try to use as few as possible, and of course would not use anything that contains synthetic fragrance, phthalates, parabens, oxybenzone, and triclosan as well as other endocrine-disrupting chemicals.

I don’t panic because I used the wrong shampoo once or wore makeup containing an ingredient I normally avoid.

And I don’t do any form of aggressive detoxing while I’m pregnant. When I do talk about detoxing during pregnancy, I mean reducing my ongoing exposure to things I don’t want around me in the first place. I don’t do cleanses, take detox supplements, fast, or experiment with herbal protocols during pregnancy. In fact, I mostly avoid herbs during pregnancy.

For me, pregnancy is a good time to simplify and play it safe.

4. I’m very cautious about medication, including during labor

I’ve always been extremely sensitive to medication, so this is something I think about throughout pregnancy and especially when I’m preparing for birth. My preference is to use as little medication as I reasonably can.

That applies to everyday medications during pregnancy, but it also influences the way I approach labor. When possible, I aim for an unmedicated birth and prefer to avoid or minimize things like nitrous oxide, epidural medication and medications used for induction.

This is very personal to me.

I’m not aware of evidence showing that having a common MTHFR variant means someone should avoid an epidural or induction medications. My caution comes much more from knowing how sensitive my own body is to medication and wanting to limit unnecessary exposure whenever I have a reasonable choice.

During pregnancy, I also don’t casually start or stop medication on my own. Some medications are important for the health of the mother or baby, and in certain situations, avoiding a needed medication can carry more risk than taking it.

Labor is similar. There are many different ways to manage pain during labor, and medication-free approaches can include movement, water, massage, breathing techniques and other forms of support.

Induction medications are another area where I prefer to use the minimal dosage possible. I’ve been induced twice and went into labor on such minimal doses that I couldn’t imagine experiencing anything at higher doses.

Because I tend to react strongly to medication, I want my birth team to know that before labor ever begins. I also like to know why something is being recommended.

• Is this medically necessary right now?
• What happens if we wait?
• Are there other options?
• What are the benefits and risks in my particular situation?
• Can we start with the lowest effective dose if medication is needed?

Those are the kinds of questions I ask and the things I advocate for. My goal is to let labor unfold with as little intervention as possible when it is safe to do so.

Does MTHFR mean you need to do these things?

There isn’t a universal MTHFR pregnancy protocol, and a common MTHFR variant on its own generally doesn’t require a special pregnancy treatment plan. But for me, finding out that I had MTHFR prompted me to look more closely at nutrition, supplements, and pregnancy in general. Then my own pregnancy experiences shaped what I actually do.

My progesterone routine comes from my history of low progesterone and needing supplementation. My preference for methylated vitamins began after learning about MTHFR. Reducing environmental exposures is something I choose to prioritize even more while I’m pregnant.

Another woman with the exact same MTHFR variant could have a completely different medical history and a completely different pregnancy plan.

If you’ve recently found out you have an MTHFR variant, I definitely wouldn’t panic. A few adjustments to your lifestyle (and possibly your supplements) is probably all that’s needed. And if you’re pregnant, definitely look into progesterone testing in the first trimester.

I’ve learned to speak up early

More than anything, my pregnancies have taught me to advocate for myself from the beginning. My doctor is an expert in their field, but I am an expert in ME, so me and my doctor are a team.

When I get a positive pregnancy test, I call and ask for what I want. I explain my history and ask about progesterone and hCG. Since I’ve needed supplemental progesterone in previous pregnancies, I bring it up immediately. Over the years, I’ve become much more comfortable asking questions, even when something isn’t automatically part of the standard early-pregnancy protocol.

If you have MTHFR and you’re pregnant or trying to conceive, bring that information to your doctor along with the rest of your medical and pregnancy history. Find out what your particular variant means, understand what the research actually says, and make your decisions from there.