Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE NG247,NICE CG156.
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 NICE NG247,NICE CG156. 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 NICE NG247. It is important to take supplements even if food is fortified with folic acid NICE NG247. Healthy Start vitamins provide a daily 400 microgram dose of folic acid, along with vitamins C and D NICE NG247.
- 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 NICE NG247. 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) NICE NG247.
- 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 NICE NG247.
- 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 NICE NG247.
- 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 NICE NG247. Support should be offered to address any reasons or barriers to taking the recommended supplement, including individualised information and follow-up reminders NICE NG247.