What role does folic acid supplementation play in the prevention of spina bifida, and what are the current guidelines for its use?

Folic acid supplementation plays a crucial role in preventing neural tube defects, such as spina bifida, by reducing the risk of these congenital malformations when taken before conception and during early pregnancy ¹,².

Current Clinical Guidelines for Folic Acid Use:

• Standard Dose: Anyone who may become pregnant, is planning a pregnancy, or is in the first 12 weeks of pregnancy should be advised to take 400 micrograms (0.4 mg) of folic acid daily ¹,². Ideally, this supplementation should begin three months before trying for a baby or as early as possible after a positive pregnancy test, continuing for at least the first 12 weeks of pregnancy ¹. It is important to take supplements even if food is fortified with folic acid ¹. Healthy Start vitamins provide a daily 400 microgram dose of folic acid, along with vitamins C and D ¹.
• High Dose (5 mg): A high-dose folic acid supplement (5 mg a day) should be offered to individuals planning to become pregnant or in the first 12 weeks of pregnancy if they have an increased risk of having a baby with a neural tube defect or other congenital malformation ¹. This includes those who (or their partner) have a neural tube defect or a family history of one, have had a previous pregnancy affected by a neural tube defect, have type 1 or type 2 diabetes, have a haematological condition requiring folic acid (e.g., sickle cell anaemia or thalassaemia), or are taking medicines that affect folic acid absorption or metabolism (e.g., anti-epileptic medicines or HIV medicines) ¹.
• Specific Considerations:
  • Individuals with a body mass index (BMI) of 25 kg/m² or more, or those with an increased risk of pre-eclampsia, do not need to take more than 400 micrograms of folic acid daily, unless they have any of the high-risk factors listed above ¹.
  • Those who have had bariatric surgery and are planning a pregnancy or are pregnant should contact their bariatric surgery unit for individualised, specialist advice on folic acid and other micronutrients ¹.
• Communication and Adherence: Healthcare professionals should discuss the importance of folic acid with anyone who may become pregnant or is pregnant, providing information in their preferred format and relevant to their circumstances ¹. Support should be offered to address any reasons or barriers to taking the recommended supplement, including individualised information and follow-up reminders ¹.