Folic Acid vs Folate: What’s Best During Pregnancy?

When you're pregnant or trying to conceive, you’re likely to come across recommendations to take folic acid. But you may also see the term folate, and wonder, are they the same thing? Which is better? And what should you be taking to best support your baby's development?

This blog will break down the difference between folate and folic acid, explain how they support a healthy pregnancy, and help you make the most informed decision for your prenatal nutrition.

What Is Folate?

Folate is a naturally occurring B-vitamin (vitamin B9) found in foods like leafy greens, citrus fruits, beans, and liver. It's crucial for DNA synthesis, red blood cell formation, and most importantly during pregnancy – the proper development of your baby’s neural tube, which becomes the brain and spinal cord.

Folate deficiency during early pregnancy is associated with an increased risk of neural tube defects (NTDs), such as spina bifida. That’s why health authorities recommend folate supplementation for all women of childbearing age and throughout pregnancy⁴.

What Is Folic Acid?

Folic acid is the synthetic form of folate. It’s the version most commonly found in standard prenatal supplements and fortified foods like cereals and breads. It was introduced in the mid-20th century to help reduce rates of birth defects – and it has made a significant impact.

However, folic acid isn’t biologically active until it’s converted by the body into a usable form. For many people, especially those with certain genetic mutations (like MTHFR), this conversion may be inefficient.

Folic Acid vs Folate: Key Differences

• Structure: Folic acid is synthetic; folate is natural.
• Sources: Folic acid comes from supplements/fortified foods; folate comes from food and active-form supplements.
• Bioavailability: Folic acid requires conversion; some forms of folate (like 5-MTHF) are already active.
• Genetic considerations: People with MTHFR mutations may not process folic acid effectively.

What is 5-MTHF and Why Does It Matter?

5-MTHF (5-methyltetrahydrofolate) is the active form of folate that your body uses directly. Unlike folic acid, it doesn’t require conversion. Supplementing with 5-MTHF may be a more effective option – especially for those who cannot efficiently process folic acid.

Emerging research suggests that 5-MTHF may be better tolerated and provide more consistent folate status in the body, particularly for those with known MTHFR polymorphisms.

Which One Should You Take in Pregnancy?

The UK’s NHS recommends all women take 400 micrograms (mcg) of folic acid daily while trying to conceive and for the first 12 weeks of pregnancy⁴. However, they also recommend continuing folate supplementation throughout pregnancy to support healthy development. Because folate is the bioavailable form, we recommend choosing folate (5-MTHF) where possible to ensure your body can use it efficiently.

If you’ve experienced miscarriage, neural tube defect risk, or known MTHFR gene variants, you may wish to discuss using a supplement containing 5-MTHF with your healthcare provider.

Benefits of Active Folate (5-MTHF) in Pregnancy

• Bypasses the MTHFR enzyme pathway
• Directly supports neural tube development
• Improves folate levels even in those with poor conversion
• May reduce risk of unmetabolised folic acid accumulation

What to Look For in a Pregnancy Supplement

Look for supplements that clearly list 5-MTHF or “methylated folate” on the label. Some will list it as “Quatrefolic®” or “Metafolin®” – both highly bioavailable forms.

We recommend Zita West Folate - Highly Absorbable Quatrefolic® for Fertility and Pregnancy. 

FAQs

References

1. A T Wondemagegn, M Afework. The association between folic acid supplementation and congenital heart defects: Systematic review and meta-analysis. NIH
2. Y Menezo, K Elder, A Clement, P Clement. Folic Acid, Folinic Acid, 5 Methyl TetraHydroFolate Supplementation for Mutations That Affect Epigenesis through the Folate and One-Carbon Cycles. NIH
3. M Samaniego-Vaesken, C Morais-Moreno, A Carretero-Krug, A M Puga, A M Montero-Bravo, T Partearroyo, V Gregorio. Supplementation with Folic Acid or 5-Methyltetrahydrofolate and Prevention of Neural Tube Defects: An Evidence-Based Narrative Review. NIH
4. UK NHS: Folic acid guidance for pregnancy – nhs.uk