During pregnancy, ensuring adequate intake of vitamin B9—commonly known as folate—is essential for your baby’s healthy development, especially during preconception and the first trimester.

But not all forms of this vital nutrient are created equal. It’s critical to distinguish between folate, the natural form found in foods, and folic acid, the synthetic version used in most supplements and fortified foods.

Folate and Folic Acid: What’s the Difference?

• Folate: Naturally occurring vitamin B9, present in foods like leafy greens, lentils, and avocados. It’s in a bioavailable form and ready for the body to use. This is the form we’ve chosen for Tend. 

• Folic Acid: A man-made compound created to mimic folate. It requires conversion into the active form, 5-methyltetrahydrofolate (5-MTHF), to be used by your body. This conversion process is not always efficient.

• Synthetic 5-MTHF: Sometimes labeled as Quatrefolic or other branded forms, synthetic 5-MTHF is a man-made version of bioavailable folate. While it’s a better alternative to folic acid, it still has drawbacks. This synthetic version of methylated folate has been marketed as the solution for people who have a genetic mutation to the MTHFR gene, but research indicates dosage is more important than which synthetic version to choose. Synthetic 5-MTHF is derived from synthetic folic acid, an inexpensive raw material. This lower cost makes it appealing to manufacturers but it’s still artificially produced, not from natural whole-food sources.

• You’ll want to look for the ACOG-recommended level of 600 mcg DFE of folate. More folate is not necessarily better for preventing spinal birth defects in your baby. 

The Science Behind MTHFR Mutations and Folate Metabolism

The enzyme methylenetetrahydrofolate reductase (MTHFR) is essential for converting folic acid into 5-MTHF, the active form of vitamin B9. However, mutations in the MTHFR gene can significantly impair this conversion.

1. The C677T Mutation:
• This mutation involves a single nucleotide change in the MTHFR gene (cytosine to thymine at position 677), leading to an enzyme that is thermolabile (unstable at higher temperatures).
• Individuals with two copies of the mutation (homozygous TT genotype) exhibit a 70% reduction in MTHFR activity. Heterozygous individuals (CT genotype) experience a 30-40% reduction. (Source: PMID 11289693)
  
  
2. Impact on Folate Conversion:
• Reduced MTHFR activity limits the conversion of folic acid to 5-MTHF.
• This results in lower bioavailability of active folate and can lead to elevated homocysteine levels, which are associated with increased risks of miscarriage, neural tube defects, and cardiovascular issues.
  
  
3. Homocysteine and Health Risks:
• Homocysteine, an amino acid byproduct, must be recycled into methionine with the help of 5-MTHF. Elevated homocysteine due to folic acid inefficiency can lead to miscarriage and other health risks.
  (Source: PMID 12066115)
  
  
4. Prevalence of MTHFR Mutations:
• An estimated 40-60% of the population carries at least one copy of the C677T mutation, making this a widespread concern for folic acid supplementation.

The Problem with Synthetic Folic Acid

Synthetic folic acid must undergo enzymatic conversion to 5-MTHF for the body to use it. This is a slow process even in individuals without MTHFR mutations.

Many prenatal supplements on the market contain more than the ACOG-recommended  600 mcg DFE of folate, typically as the synthetic form, folic acid. Excess folic acid that isn’t converted can accumulate in the bloodstream as unmetabolized folic acid (UMFA).

UMFA has been linked to immune dysfunction and a potential increased risk of cancer. (Source: PMID 15531663)

Isn’t Folic Acid Essential for Preventing Birth Defects?

Folic acid has long been credited with reducing neural tube defects (NTDs). However, ensuring adequate vitamin B9 levels is the key—not the synthetic form itself.

Countries using food fortification with folic acid have seen reductions in NTD rates. But this approach isn’t without risks, including the potential buildup of unmetabolized folic acid.

Natural folate from whole foods provides the same protective effects while avoiding synthetic drawbacks.

Real Food Sources of Folate

If you are consuming a healthy, nutrient-dense diet (or taking a comprehensive, whole food sourced prenatal like Tend), you likely don’t need synthetic folic acid or even synthetic 5-MTHF to meet your vitamin B9 needs. Folate-rich foods include:

• Leafy Greens: Spinach, kale, and Swiss chard.
• Legumes: Lentils, chickpeas, and black beans.
• Citrus Fruits: Oranges, grapefruits, and lemons.
• Avocado: A versatile folate powerhouse.
• Eggs: Especially the yolks.

Key Takeaways: Why Natural Folate is Preferable

• Folic Acid ≠ Folate: Folic acid is synthetic and must be converted by the MTHFR enzyme to be usable.
• MTHFR Variations Matter: Up to 60% of people have mutations that reduce their ability to process folic acid efficiently.
• Immediate Bioavailability: Natural folate (5-MTHF) bypasses the need for MTHFR-dependent conversion.
• Synergy of Nutrients: Folate from whole foods comes with additional nutrients that enhance absorption and function.
• Lower Risk: Natural folate doesn’t lead to UMFA or homocysteine buildup, reducing potential health risks.
• Choose Real Food: Natural folate from foods is the most bioavailable and beneficial form of vitamin B9.

At Tend, we’ve harnessed the power of natural folate by creating a synthetic-free prenatal vitamin bar made entirely from real foods. Unlike synthetic pills or gummies, our nutrients are naturally absorbed by your body, making them more effective for your health and your baby’s development. Research shows that all nutrients, including 5-MTHF, are more efficiently utilized when consumed as part of whole foods. This synergy allows your body to use nutrients as intended.

Why Tend

We started Tend because moms deserve better. Prenatal nutrition has relied on outdated solutions like synthetic pills, which don’t work for every mom or baby.

That’s why we created Tend: the world’s first prenatal vitamin made entirely from real food. Our philosophy is simple—real food nutrients, better absorption, and no synthetic shortcuts. Unlike synthetic supplements, our products deliver vitamins and minerals in their natural, bioavailable form, ensuring they’re truly effective for both mom and baby.

Moms deserve complete transparency and the confidence that comes with knowing exactly what they’re putting into their bodies. We are proud to be the first prenatal company to conduct and publish third-party testing for every ingredient. With Tend, you can embrace your pregnancy journey with confidence, supported by nutrition designed to truly nourish you and your baby.