For professional use only 

What’s the Difference and Why It Matters for Your Patients.

You’re already aware of the importance of folate during the preconception period and early pregnancy. But many patients still don’t know the difference between folic acid and folate and some supplements don’t make it easy to spot either.

As a healthcare professional, understanding how these two forms differ, and when one might be more suitable than the other, can help you guide patients toward more informed decisions, especially when they’re trying to conceive.

Folate – A Vital Nutrient for Pregnancy

When it comes to pregnancy, arguably the most commonly discussed nutrient is folate. Almost all medical professionals will recommend supplementation prior to and during pregnancy because it’s known to reduce the risk of neural tube defects, which can impact a baby’s brain or spine.

However, folate’s role in pregnancy goes beyond neural tube development. It’s fundamental for fetal growth, DNA synthesis and cellular development particularly in those critical early weeks of gestation when many women may not yet know they’re pregnant.

Folate is a vital nutrient for a healthy pregnancy.

Folic Acid vs. Folate – The Basics

• Folate is the naturally occurring form of vitamin B9 found in foods like leafy greens, beans, and citrus fruits. In the body, it needs to be converted into its active form 5-Methyltetrahydrofolate (5-MTHF) before it can be used to support essential processes like DNA synthesis, cell division, and neural tube development.
• Folic acid, on the other hand, is the synthetic version commonly used in fortified foods and standard prenatal vitamins. It’s stable and cost-effective, which is why it’s used in most public health recommendations. However, folic acid still needs to be converted into 5-MTHF in the liver before it can become active, and that’s where things get more complex.

Not Everyone Can Convert Folic Acid Efficiently

In order for the body to use folic acid, it must first be converted into 5-MTHF, the bioactive form of folate. Most of the folate in the bloodstream exists in this methylated form in fact, 5-MTHF represents 95–98% of folate in serum or red blood cells.

Up to 60% of people carry a variation in the MTHFR gene, which can significantly impair the body's ability to convert folic acid into 5-MTHF. This means that even if someone is taking the recommended amount of folic acid daily, they may not be getting the benefit their body actually needs, especially during that critical window before and during early pregnancy.

This is where supplementing with the active form (5-MTHF) becomes particularly beneficial. By giving the body folate in its ready-to-use form, you bypass the need for conversion entirely.

Why This Matters in Fertility and Pregnancy

For women trying to conceive or undergoing fertility treatment, having sufficient folate available is key. It supports healthy egg development, DNA repair, and helps to prevent neural tube defects during the early stages of pregnancy.

When folic acid conversion is impaired, unmetabolised folic acid can build up in the bloodstream. While research is ongoing, there are growing concerns about potential links to immune function disruption and masking of B12 deficiency.

Using a supplement that provides folate in its active, methylated form (5-MTHF) ensures your patient is getting a form their body can immediately use, reducing the chance of ineffective conversion and supporting better outcomes.

In Summary

• Folic acid and folate are not the same - only folate in its active form (5-MTHF) is immediately usable by the body.

• Up to 60% of patients have a reduced ability to convert folic acid due to MTHFR gene variants.

• Using 5-MTHF supports absorption, avoids build-up of unmetabolised folic acid, and ensures patients are getting the full benefit of their supplement.

• Proceive® only uses 5-MTHF, offering confidence in formulation and effectiveness.

References

Francesco Scaglione & Giscardo Panzavolta (2014) Folate, folic acid and 5-methyltetrahydrofolate are not the same thing, Xenobiotica, 44:5, 480-488, DOI: 10.3109/00498254.2013.845705