New recommendations for folic acid supplementation to prevent neural tube defects

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  • The US Preventive Services Task Force (USPSTF) recommends that all women of reproductive age take a daily folic acid supplement to reduce risks for neural tube defects.

Why this matters

  • Neural tube defects are defects of the brain and spine affecting 6.5 cases per 10,000 live births.
  • Most neural tube defects occur spontaneously, but risk factors include a personal or family history.
  • One half of US pregnancies are unplanned; this recommendation should apply to all women of reproductive age and be part of preconception counseling.
  • This recommendation reaffirms the 2009 recommendation statement.

Key results

  • The USPSTF recommends “all women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg of folic acid."
  • The UTPSTF did not find clear evidence regarding varying dosage, timing, or duration of supplementation.
  • The critical period is 1 mo prior to pregnancy and first 2-3 mo of pregnancy.
  • Rates of neural tube defects have declined since the fortification of foods in 1998.

Study design

  • Review of literature and expert recommendations by the USPSTF.
  • Funding: The Agency for Healthcare Research and Quality.


  • More research is needed on differences in ethnic/racial populations.