The US Preventive Services Task Force (USPSTF) recommends that all women who are capable of pregnancy or are planning to become pregnant take a daily supplement of 0.4 to 0.8 mg of folic acid, according to its recommendation statement published in JAMA.
The USPSTF gave an A grade to its recommendation, which reaffirms its 2009 recommendation of folic acid supplementation for women of childbearing age for prevention of neural tube defects.
The task force examined the benefits and harms of folic acid in this population and determined that the net benefit is substantial. The USPSTF also found substantial evidence that the supplements provide substantial benefit in the periconceptional period in reducing the risk of neural tube defects in the developing fetus. In addition, the harms of folic acid to the mother or the infant are small when taken at the usual doses.
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The USPSTF notes that clinicians should advise all women who are capable of pregnancy to take daily folic acid supplements. The critical period for folic acid supplementation starts about 1 month before conception and continues through the first 2 to 3 months of pregnancy.
In an accompanying editorial, James L. Mills, MD, MS, from the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, notes that current food fortification may prevent most folate-related neural tube defects. However, the habitual use of folic acid supplements is a more reliable method of ensuring adequate levels than diet.
“The USPSTF recommendation that all women of childbearing age take folic acid supplements is a prudent one,” he stated. “Ideally, it will educate all women who are planning or capable of pregnancy to follow this recommendation and thereby reduce the risk of these severe birth defects in their infants.”
Laurie E. Mitchell, PhD, from the Department of Epidemiology, Human Genetics and Environmental Sciences and Human Genetics Center, at the University of Texas School of Public Health, stated in an additional editorial that there is still considerable room for improvement in the use of folic acid supplements in populations of women who may potentially become pregnant.
“The current recommendation statement should serve as a catalyst for renewed efforts to develop and deliver folic acid messages that will translate into further reductions in the population prevalence of neural tube defects,” she concluded.
References
- US Preventive Services Task Force. Folic acid supplementation for the prevention of neural tube defects: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(17):183-189. doi:10.1001/jama.2016.19438
- Mills JL. Strategies for preventing folate-related neural tube defects supplements, fortified foods, or both? JAMA. 2017;317(2):144-145. doi:10.1001/jama.2016.19894
- Mitchell LE. Folic acid for the prevention of neural tube defects: The US Preventive Services Task Force statement on folic acid supplementation in the era of mandatory folic acid fortification. JAMA Pediatrics. 2017. doi:10.1001/jamapediatrics.2016.4983
