Most parents-to-be know how important folate is during pregnancy.

But I’m guessing you’re reading this because you’ve also heard about something called methylfolate or been told to take a folic acid supplement - and now you’re wondering what the difference is and what it means for you and your pregnancy.

If that’s the case, here’s the low down on folate vs methylfolate vs folic acid.

Firstly, what is folate and why is it so important during pregnancy?

Folate, also known as B9, is one of the 13 essential vitamins.

‘Essential’ means it can’t be made by the body and must be provided through the diet.

Everyone needs folate, but it’s especially important for pregnant women.

That’s because it’s crucial for fetal growth and development and plays a key role in the formation of the neural tube, a layer of cells that forms into a tube that later becomes the brain and spinal cord.

If the tube doesn’t fuse properly, it can result in a ‘neural tube defect’ such as spina bifida.

Most people can get the folate they need through their diet, but requirements for folate increase during pregnancy, and diet alone may not provide enough.

Because of this, pregnant women are generally advised to take a folic acid supplement.

Folate vs folic acid

While folate is naturally occurring, folic acid is a synthetic (manmade) version that is present in dietary supplements (such as prenatal vitamins).

It’s also added to certain foods such as flour and breakfast cereals to increase their folate content (more on that later).

Taking a folic acid supplement at around the time of conception and during pregnancy has long been known to reduce the risk of neural tube defects in babies.

How much folate/folic acid is needed during pregnancy?

In Australia, the recommended daily intake for folate during pregnancy is 600µg/day (1µg or 1 microgram is 1 millionth of a gram).

This is increased from 400µg/day for non-pregnant women.

If you’re planning on having a baby, it’s recommended that you start taking a folic acid supplement as well as including folate-rich foods in your diet for at least one month before becoming pregnant to reduce the risk of a neural tube defect.

As well as helping to prevent neural tube defects, folic acid supplementation in preconception and in the early stages of pregnancy has been found to have other benefits such as reducing the risk of preterm birth, congenital heart disease and oral clefts (Obeid et al.,2019).

What are the best sources of folate?

Even if you’re taking a folic acid supplement, it’s a good idea to also include plenty of folate-rich foods in your diet during pregnancy.

Folate is found in foods such as leafy green vegetables, egg yolk, legumes and citrus fruits.

Below is the folate content of some of the most naturally folate-rich foods:

Leafy green vegetables such as spinach and broccoli
Legumes, such as kidney beans and lentils
Rice
Avocado
Citrus fruits
Asparagus
Brussels Sprouts
Avocado
Beetroot
Nuts and seeds
Beef liver

Some foods have folic acid added to them to increase their folate content, for example:

Bread (in Australia, there is mandatory fortification of all non-organic bread-making flour with folate)
Breakfast cereal
Fruit juice
Vegemite

What is methylfolate?

Neither folate nor folic acid can be used by the body in their existing form.

Both need to be converted into other forms in order to be biologically active (this is, to perform their functions within the body). The main active form of folate is 5-methyltetrahydrofolate (5-MTHF).

This process of converting folate into 5-MTHF requires an enzyme called methylenetetrahydrofolate reductase (MTHFR).

The MTHFR Gene Mutation

Within the human genome, there are many genetic variations, called polymorphisms.

In some cases, these variations can result in the production of proteins with altered biological activity.

Several polymorphisms have been identified in the genes which encode the proteins involved in folate metabolism.

We all have two copies of the MTHFR gene - one from mum and one from dad.

Some people may have a polymorphism in one copy and another working copy. The people will produce up to 50% less MTHFR enzyme.

If a person has a polymorphism in both copies of the MTHFR gene, the amount of MTHFR enzyme they produce will be significantly reduced (up to 2/3 lower than normal).

It’s estimated that up to 60% have a polymorphism of the MTHFR gene.

How do I know if I have the MTHFR mutation?

To determine whether a polymorphism of the MTHFR gene is present, a genetic test is needed.

Some health practitioners can order these tests, however, at this stage, many health organisations don’t recommend MTHFR gene testing due to a lack of evidence that the test will have any effect on an individual’s health.

What does it mean if you have the MTHFR gene mutation?

Having an MTHFR gene mutation means you may have a reduced ability to produce the MTHFR enzyme needed to convert folic acid into its active form, l-methylfolate.

If folic acid can’t be used effectively, and there’s inadequate folate in the diet to meet requirements, this can increase the risk of neural tube defects.

However, its not yet known the exact implications of MTHFR variants and it remains a controversial topic in the medical world, with some health organisations stating that MTHFR gene mutations are not clinically significant on their own and do not cause health problems in the majority of people.

Methylfolate vs folic acid supplements

While research in this area is lacking at this point in time, for people with the MTHFR mutation, methylfolate or folinic acid supplementation may be more suitable than folic acid supplementation. However, it’s best to speak to a prenatal dietitian to determine the most suitable prenatal vitamin for your pregnancy.

For people with normal MTHFR gene variations, folic acid supplements are suitable.

The downside of methylfolate is that it does cost significantly more than folic acid, which is why it’s not used more widely in prenatal supplements.

Please note - this is general advice only. If you have any concerns about your pregnancy and health, make sure you speak to your doctor.