Where We Stand: Folic Acid

In an effort to reduce the prevalence of spina bifida, the American Academy of Pediatrics (AAP) endorses the recommendation of the US Public Health Service that all women capable of becoming pregnant consume 400 micrograms per day of folic acid (a B vitamin). Folic acid helps to prevent neural tube defects (NTD), which include spina bifida. Although some foods are fortified with folic acid, it is not possible for women to meet the 400 microgram goal through a typical diet. Thus, an Academy policy statement recommends a daily multivitamin tablet that contains folic acid in the recommended dose. Studies show that if all women of childbearing age met these dietary requirements, 50 percent or more of NTDs could be prevented.

Women who are at high risk for an NTD-affected pregnancy (for example because of a previous NTD-affected pregnancy, having diabetes mellitus, or taking antiseizure medications) are advised to discuss their risk with their doctor. This includes possible treatments with very high doses of folic acid (4,000 micrograms per day), beginning one month before becoming pregnant and continuing throughout the first trimester. As the doctor will explain, however, women should not attempt to achieve this very high dose of folic acid by taking multivitamin supplements, but rather only under the care of a physician.