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Occurrence Prevention

The U. S. Public Health Service and CDC recommend that all women of childbearing age
consume 0.4 mg (400 micrograms) of folic acid daily to prevent two common and serious
birth defects, spina bifida and anencephaly.
All women between 15 and 45 years of age should consume folic acid daily because half of
U.S. pregnancies are unplanned and because these birth defects occur very early in pregnancy
(3-4 weeks after conception), before most women know they are pregnant.
CDC estimates that most of these birth defects could be prevented if this recommendation
were followed before and during early pregnancy.
[Read more about this recommendation]

Recurrence Prevention
All women who have already had an NTD-affected pregnancy should consume 0.4 mg (400
micrograms) of folic acid every day when not planning to become pregnant.
When these women are planning to become pregnant, they should consult with their health
care provider about the desirability of following the August 1991 U.S. Public Health Service
guideline. The guideline called for consumption of 4 milligrams (4000 micrograms) of folic
acid daily beginning one month before they start trying to get pregnant and continuing
through the first three months of pregnancy.
Although it appears that a lower dose, such as 0.4 milligrams, may have as great a beneficial
effect as 4.0 milligrams, many health care providers recommend the higher dose. This
recommendation is based on data from the most rigorous scientific study involving women
who had previous pregnancies affected by neural tube defects. This dosage should be
prescribed and monitored by the health care provider. Typically, a health care provider will
prescribe one prenatal vitamin plus three 1 mg tablets of folic acid a day to get this dosage.
Keep in mind that we do not understand all the causes of neural tube defects. We do know
that most can be prevented by consuming sufficient amounts of folic acid.
[Read more about this recommendation]

Institute of Medicine (IOM) Recommendation

In 1998, the Food and Nutrition Board of the National Academy of Sciences Institute of
Medicine (IOM) recommended that to reduce their risk for an NTD-affected pregnancy,
women capable of becoming pregnant should take 400 micrograms of synthetic folic acid
daily, from fortified foods or supplements or a combination of the two, in addition to
consuming food with folate from a varied diet.
[Read more about this recommendation]

U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force recommends that all women planning or capable of
pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 g) of folic acid.
This recommendation received a Grade: A.

Current Issues
You may see articles and news reports on new research findings that could lead to
questioning your course of action. Evidence must be strong before changes in
recommendations are made by CDC. If you would like discuss some of these issues with your
colleagues, we suggest joining the National Birth Defects Prevention Network listserv.

Related Links

Healthy Pregnancy

Spina Bifida

Birth Defects

A-Z Index of Birth Defects, Blood Disorders & Disabilities

Page last reviewed: April 28, 2015

Page last updated: April 28, 2015

Content source:
o Division of Birth Defects, National Center on Birth Defects and
Developmental Disabilities, Centers for Disease Control and Prevention

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