Clinician Summary

Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication

August 01, 2023

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Expand All
Panel 1
What does the USPSTF recommend?

Persons who plan to or could become pregnant:
Take a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid.
Grade: A

To whom does this recommendation apply? This recommendation applies to all persons who are planning to or could become pregnant. It does not apply to persons who have had a previous pregnancy affected by neural tube defects or who are at very high risk due to other factors such as family history or those taking medication known to block the function of folic acid.
What’s new? This recommendation is consistent with the 2017 USPSTF recommendation.
How to implement this recommendation?   All persons who are planning to or could become pregnant should take a daily supplement or multivitamin containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid.
What additional information should clinicians know about this recommendation?
  • Supplementation should be taken daily. The critical period for folic acid supplementation starts at least 1 month before conception and continues through the first 2 to 3 months of pregnancy.
  • Nearly half of all pregnancies in the US are unplanned, meaning that many persons may not know they are pregnant during the crucial time. To gain the full benefits of supplementation, clinicians should advise all persons who plan to or who could become pregnant to take a daily folic acid supplement.
Why is this recommendation and topic important?
  • Neural tube defects are caused by a failure of closure of the embryonic neural tube, which results in birth defects of the brain, spinal cord, and overlying tissues. The most common forms of neural tube defects are anencephaly, encephalocele, and spina bifida.
  • Neural tube defects are among the most common congenital malformations in the US, with an estimated 3000 pregnancies affected each year. Neural tube defects can result in death and a range of disabilities affecting children.
  • Daily supplementation with folic acid is shown to prevent neural tube defects.
What are additional tools and resources? The Community Preventive Services Task Force recommends community-wide education campaigns to promote the use of folic acid supplements among persons of childbearing age (https://www.thecommunityguide.org/findings/pregnancy-health-community-wide-campaigns-promote-use-folic-acid-supplements.html).
Where to read the full recommendation statement? Visit the USPSTF website (https://www.uspreventiveservicestaskforce.org/) or the JAMA website (https://jamanetwork.com/collections/44068/united-states-preventive-services-task-force) to read the full recommendation statement. This includes more details on the rationale of the recommendation, including benefits and harms; supporting evidence; and recommendations of others.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation.