MTHFR, Folic Acid & Folate: What You Need to Know Before Pregnancy

When it comes to folate, there’s a lot of information out there and it can be confusing to know which form is best for you. This isn’t about saying one form is “right” or “wrong.” It’s about understanding the differences so you and your health professional can make the choice that’s right for you.

If you’re trying to conceive or already pregnant, folate is one of the most important nutrients for your health and your baby’s development. Let’s break down the key differences between folic acid and folate, how the MTHFR gene plays a role, and why we’ve chosen the form we use in the prenatal.

🧬 Folic Acid vs. Folate: What’s the Difference?

• Folic acid is the synthetic, man-made form of vitamin B9, found in many supplements and fortified foods.
• Folate is the naturally occurring form, found in foods like leafy greens, legumes, and liver.
  

To be used by the body, folic acid must be converted into its active form 5-MTHF (methylfolate) via an enzyme produced by the MTHFR gene.

Why the MTHFR Gene Matters

Around 40-60% of people carry a variation (polymorphism) in the MTHFR gene.

• This polymorphism can reduce the efficiency of converting folic acid into its active form - especially if both copies of the gene are affected (homozygous).
• Even without the variation, the body can use methylated folate immediately, without the need for conversion.
• MTHFR variations can also be associated with elevated homocysteine levels, which have been linked to pregnancy complications and cardiovascular concerns.

Why This Matters in Fertility & Pregnancy

Folate plays a crucial role in:

• Healthy cell division
• DNA synthesis
• Early development of your baby’s neural tube

Having optimal folate status may help reduce the risk of:

• Neural tube defects
• Miscarriage
• Pre-eclampsia
• Placental complications

Because many women don’t realise they’re pregnant until several weeks in when critical early development is already underway we recommend starting a high-quality prenatal at least 3 months before conception. This ensures your folate and other key nutrients are at optimal levels well before pregnancy is confirmed.

Why We Choose Methylated Folate (5-MTHF)

• Already in the active form, so your body can use it directly - regardless of MTHFR status.
• Doesn’t require conversion by the MTHFR enzyme, which may be beneficial for people with reduced enzyme activity.
• Research suggests it may improve folate status more effectively in some individuals with genetic variations.

That’s why the prenatal contains Quatrefolic® (5-MTHF) - a clinically validated form of methylated folate - so you can feel confident you’re getting folate in its most bioavailable form.

Why Folic Acid Is Still Common

Folic acid is stable, widely available, and affordable and has been used successfully in public health fortification programs worldwide. However, there’s also a cost difference to consider:

• Folic acid costs around $85/kg
• Quatrefolic® (5-MTHF) costs around $28,000/kg

That’s more than 300× more expensive, which is one reason many companies choose folic acid. Our approach? We prioritise the most bioavailable form for every individual - so you can be supported whether or not you know your MTHFR status.

What the TGA Says:

As per the TGA website: 5-methyltetrahydrofolate (5-MTHF) is the biologically active form of folate and the form found in circulation. It does not require enzymatic conversion and can be utilised directly by the body.

A Quick Tip:

If you have an MTHFR polymorphism, it can be worth being mindful of how much folic acid you get from fortified foods like bread, milk, and cereals. A mix of natural food folate and active supplemental folate can help support optimal levels.

Thinking of Trying for a Baby?

Starting a high-quality prenatal 3 months before conception helps build nutrient stores for you and your baby - so you’re supported from the very start, even before you know you’re pregnant.q

• Quatrefolic® (5-MTHF) methylated folate
• High-dose choline (550mg)
• Optimal selenium and iodine

• Bioavailable B vitamins

Shop The Prenatal

If you’re unsure about your folate needs or curious about MTHFR testing, we recommend chatting with your integrated health professional.

References

1. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: NHMRC; 2006 (updated 2017). [Choline, Folate]

2. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press (US); 1998.

3. Caudill MA et al. Choline intake during pregnancy improves child attention and memory. FASEB J. 2018;32(4):2172–2180. doi:10.1096/fj.201700692RR

4. Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327(26):1832–1835. doi:10.1056/NEJM199212243272602

5. Lucock M. Folic acid: nutritional biochemistry, molecular biology, and role in disease processes. Mol Genet Metab. 2000;71(1-2):121–138. doi:10.1006/mgme.2000.3027

6. Lamers Y et al. Moderate dietary folate restriction and methylation demand during pregnancy affect maternal folate status and homocysteine concentrations. J Nutr. 2009;139(1):104–110. doi:10.3945/jn.108.097675

7. TGA (Therapeutic Goods Administration). Folic Acid and Folate in Listed Medicines.