Folic acid supplementation recommendations by indication

Indication for supplementation Dose Start (minimum) Duration* Recommended

(daily) by
High risk
Prior open NTD in offspring of either parent or personal
history of open NTD in either parent
4 mg Three months PTC 12 weeks SOGC , ACOG
Women on valproate or carbamazepine
Type I or II diabetes 5 mg Three months PTC 12 weeks RCOG
Body Mass Index > 30 kg/m2 5 mg Three months PTC 12 weeks RCOG
Moderate risk
Personal or family history of folate-sensitive congenital 1 mg Three months PTC 12 weeks SOGC
anomaly other than NT
Family history of NTD ( first- or second- degree relative) 1 mg Three months PTC 12 weeks SOGC
Type I or II diabetes 1 mg Three months PTC 12 weeks SOGC
Women on other antiepileptic drugs 0.4 mg One month PTC 12 weeks ADA, ACOG
Maternal gastrointestinal malabsorption 1 mg Three months PTC 12 weeks SOGC
Medical conditions associated with risk (advanced liver 1 mg Three months PTC 12 weeks SOGC
disease, dialysis, alcohol overuse)
Low risk
Pregnancy or potential for pregnancy 0.4 mg At least one month PTC 12 weeks ACOG, CDC
0.4 - 0.8 One month PTC First 2-3 months of pregnancy USPSTF
mg
NTD: neural tube defect; PTC: prior to conception; ACOG: American College of Obstetricians & Gynecologists; SOGC: Society of Obstetricians & Gynecologists
of Canada; ADA: American Diabetes Association; RCOG: Royal College of Obstetricians & Gynecologists; USPSTF: United State Preventive Services Task Force;
CDC: Centers for Disease Control & Prevention. * After 12 weeks to continue on 0.4 mg with other supplement and as required.