Methylfolate vs Folic Acid: Which Is Better?

If you've started researching pregnancy supplements, you may have come across two forms of folate: folic acid and methylfolate. The NHS recommends folic acid for all women trying to conceive and in early pregnancy — but some supplement brands market methylfolate as a superior alternative. Here's a clear, evidence-grounded explanation of what both are, how they differ, and what's actually recommended.

What Is Folic Acid?

Some women are advised to take a higher dose — 5mg per day — if they have a higher risk of having a baby with a neural tube defect. This includes women who have previously had a pregnancy affected by a neural tube defect, women with diabetes, women taking certain epilepsy medications, or women with a high BMI. If any of these apply to you, speak to your GP before conception if possible, so they can prescribe the appropriate dose.

Folic acid from food sources (natural folate) is found in dark leafy vegetables, pulses, and fortified cereals. However, diet alone is unlikely to provide sufficient folate in early pregnancy, which is why supplementation is recommended even for women who eat a well-balanced diet.

What Is Methylfolate?

The argument made for methylfolate centres on a gene variant known as MTHFR (methylenetetrahydrofolate reductase). Some people carry variants of this gene that reduce their body's ability to convert folic acid into active folate. For women with reduced MTHFR enzyme activity, methylfolate may theoretically be better absorbed and used by the body.

However, it's important to understand the current state of the evidence:

• MTHFR variants are common in the general population, but most people with these variants still process folic acid adequately
• Most women do not know whether they carry MTHFR variants — genetic testing is not routinely offered on the NHS for this purpose
• The NHS and leading UK medical organisations continue to recommend standard folic acid for all pregnant women, including those with common MTHFR variants
• Methylfolate supplements are more expensive and less well-studied in the context of pregnancy supplementation than folic acid

This does not mean methylfolate is unsafe — it is a naturally occurring form of folate. But the current mainstream guidance does not recommend it over folic acid for the general population.

Which Should You Take?

For most women, standard folic acid at the NHS-recommended dose is appropriate, well-evidenced, and sufficient. If you prefer to take a pregnancy multivitamin that contains methylfolate instead of or in addition to folic acid, this is unlikely to be harmful — but it is worth checking the folate dose (in micrograms equivalent) to ensure you're getting an adequate amount.

If you have been told you have an MTHFR variant, or if you have a personal or family history of neural tube defects, speak to your GP before choosing a supplement. They can advise whether standard folic acid, a higher dose, or an alternative form is most appropriate for you.

Avoid taking more than the recommended dose of folic acid (or any folate supplement) without medical guidance.

Frequently Asked Questions

Should I take methylfolate instead of folic acid in pregnancy?

For most women, standard folic acid is the NHS-recommended choice and is appropriate. Methylfolate may be considered by women with known MTHFR variants or those who prefer it, but it's not currently recommended over folic acid for the general population. If you're unsure, discuss it with your GP or midwife.

What is the MTHFR gene and does it affect folic acid absorption?

MTHFR is an enzyme involved in converting folic acid to its active form. Some people carry genetic variants that reduce this enzyme's activity. However, most people with common MTHFR variants still process folic acid adequately. MTHFR testing is not routinely recommended in UK pregnancy care; speak to your GP if you have concerns.

Can I get enough folate from food alone in pregnancy?

Natural folate is found in dark leafy vegetables, lentils, chickpeas, and fortified cereals. However, dietary folate alone is generally not reliable enough to meet pregnancy needs, and absorption from food varies. Supplementation with folic acid (or methylfolate) is recommended in addition to a healthy diet, not instead of it.

Speak to your GP or midwife for personal guidance on the right type and dose of folate supplement for your pregnancy.

This article is for informational purposes only and does not constitute medical advice.

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• Pregnancy Symptoms