Task Force Recommends Folic Acid to Prevent Neural Tube Defects
Aug. 15, 2023, News Staff — An updated recommendation from the U.S. Preventive Services Task Force calls for people who are planning to or could become pregnant to take a daily supplement with 0.4 to 0.8 mg of folic acid to prevent neural tube defects. Supplementation should start at least one month before anticipated conception and continue through the first two to three months of pregnancy.
The recommendation, which the task force gave an “A” grade, does not apply to individuals who have had a previous pregnancy affected by neural tube defects or who are at very high risk because of other factors, such as family history or use of certain antiseizure medications. In addition, the recommendation does not apply to individuals who take certain medications known to block the function of folic acid, such as methotrexate, carbamazepine and valproic acid.
“The task force continues to underscore the importance of taking a daily supplement containing folic acid before and during early pregnancy to help protect the health of babies,” said Katrina Donahue, M.D., M.P.H., a professor and vice chair of research in the Department of Family Medicine at the University of North Carolina School of Medicine at Chapel Hill and a member of the task force, in an agency bulletin. “By taking folic acid, people can reduce the risk of developing neural tube defects, which can result in serious complications for babies, including disability and death.”
Neural tube defects occur in about 3,000 pregnancies in the United States each year. The two most common NTDs, according to the CDC, are spina bifida and anencephaly. Although all pregnancies are at risk for NTDs, there is some evidence that certain populations may be at higher risk; pregestational diabetes and obesity also have been associated with an increased risk for NTDs.
Most NTDs are caused by low maternal levels of folate, a naturally occurring substance found in many foods. A synthetic form called folic acid is available through prenatal vitamins, multivitamins, tablets and as a food additive. Because NTDs happen early in pregnancy, often before patients know they are pregnant, several agencies in addition to the USPSTF recommend that women of reproductive age take folic acid to help prevent NTDs.
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Reaffirmation of Previous Findings
The updated recommendation statement reaffirms the task force’s January 2017 statement on the topic, which also had an “A” grade.
After conducting an evidence review that included results from a handful of new studies, the task force said there was convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid, taken during the periconceptional period, reduce the risk for neural tube defects.
The task force also found adequate evidence that taking folic acid supplements at their usual doses is not associated with serious harms.
Although the benefits of folic acid supplementation appear to be well-established, the agency called for additional research on topics such as the effectiveness of supplementation in reducing neural tube defects in populations that are disproportionately affected by the condition, and on factors that contribute to variations in adherence to supplementation.
Response to Public Comment
In response to comments on a draft version of the recommendation statement, the task force clarified that the generally available dosage for folic acid supplementation is between 0.4 and 0.8 mg daily; people at increased risk for NTDs may require higher dosages and should consult with their clinician.
The final recommendation also included more information on naturally occurring sources of folate.
Resources for Family Physicians
In support of the final recommendation statement, the USPSTF included links to a Community Preventive Services Task Force systematic review on the effectiveness of community-wide campaigns to promote the use of folic acid supplements, and links to a JAMA patient page and podcast on folic acid supplementation.
AAFP member resources include an extensive list of maternity care clinical recommendations and guidelines, a series of women’s health CME activities and an AFP by Topic collection of articles on prenatal care. Familydoctor.org, the Academy’s companion website, contains patient-centered articles on NTDs, healthy eating and pregnancy, and preconception care, all of which discuss the importance of folic acid.
Finally, the Women’s Preventive Services Initiative, an AAFP partner organization, has published several recommendations and resources for family physicians and other health care professionals who care for patients before, during and after pregnancy.