Pre-conception folic acid — MRCGP AKT MCQ

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EasyObstetrics & GynaecologyPre-conception folic acidMRCGP AKT UKMLA PARA

A 34-year-old woman with a BMI of 31 kg/m² is planning a pregnancy. She takes no regular medicines and has no other relevant medical or family history. What dose of folic acid should she take before conception and until 12 weeks' gestation?

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Correct answer: B — 400 micrograms daily

The correct answer is 400 micrograms daily. NICE advises this dose for anyone planning pregnancy, continuing through the first 12 weeks. Since January 2025, NICE has specifically advised that a BMI of 25 kg/m² or more does not, by itself, justify high-dose folic acid. A 5 mg daily dose is reserved for additional risk factors, such as personal, partner or family history of a neural tube defect, a previous affected pregnancy, type 1 or type 2 diabetes, relevant haematological disease, or medicines affecting folate metabolism or absorption. None is present here. There is no standard UK recommendation for 800 micrograms or 10 mg daily in this situation. No supplementation is incorrect because routine periconceptional folic acid reduces the risk of neural tube defects.

Reference: National Institute for Health and Care Excellence. NG247: Maternal and child nutrition: nutrition and weight management in pregnancy, recommendations 1.1.4–1.1.6. 2025. https://www.nice.org.uk/guidance/ng247/chapter/Recommendations