Online Exclusives

U.S. Government Reaffirms Folic Acid Recommendation for Healthy Pregnancy

By Sean Moloughney, Editor | January 17, 2017

Folic acid supplementation is proven to prevent neural tube defects in babies.

The U.S. Preventive Services Task Force (USPSTF) recommends that all women who are planning or capable of pregnancy should take a daily supplement containing 0.4 to 0.8 mg (400-800 µg) of folic acid in order to prevent birth defects. The updated recommendation, which followed an examination of new evidence on the benefits of folic acid supplementation, was published in JAMA on Jan. 10.

Folic acid is required for the metabolism of specific biochemical reactions and cell division in the body. It plays a significant role in the development of the nervous system in the growing fetus. Moreover, it is involved in the formation of red blood cells, supporting the normal development of the neural tube, which is a part of the embryo that eventually forms the brain and spinal cord.

Research in 1991 found that women who took folic acid supplements prior to conception reduced their risk for having a child with spina bifida or other neural tube defects by more than 50%.

The next year the U.S. Public Health Service (USPHS) recommended that all women of childbearing age capable of becoming pregnant take 400 µg of folic acid per day. According to an editorial published in the Jan. 10 issue of JAMA, “The rationale for this broad recommendation was that approximately half of pregnancies are unplanned.” In 2009, the USPSTF first recommended that all women planning or capable of pregnancy take 400 to 800 µg of folic acid daily. The updated USPSTF recommendation statement reaffirms that position.

Neural tube defects are among the most common major congenital anomalies in the U.S. and may lead to a range of disabilities or death. While daily folic acid supplementation around the time of conception can prevent neural tube defects, most women do not receive the recommended daily intake of folate from diet alone.

Globally, retail value sales of pediatric vitamins and dietary supplements (VDS) along with pregnancy multivitamins grew 34% between 2008 and 2013 to reach $4.7 billion, according to 2014 data from Euromonitor International.

Duffy MacKay, ND, senior vice president, scientific and regulatory affairs, Council for Responsible Nutrition (CRN), applauded the USPSTF for its continued recommendation. “Folic acid supplementation is proven to prevent neural tube birth defects in babies, and we commend the U.S. Preventive Services Task Force for its continued recommendation that all women of child-bearing age supplement with folic acid to avoid experiencing this devastating birth defect. Specifically, the USPSTF recommendation calls for all women who are planning a pregnancy or are capable of becoming pregnant to supplement with 0.4 to 0.8 mg of folic acid. This amount is typically found in multivitamins and pre-natal vitamins and consumers should check labels and talk with their healthcare practitioner to ensure they’re getting the right amount.”

Despite food fortification efforts, essential nutrients aren’t always easily attained through diet alone, which the USPSTF report acknowledged, Dr. MacKay added.

“Government data have repeatedly validated that there is ‘considerable room for improvement in the use of folic acid supplements across the population of reproductive-age women,’ as stated in the accompanying editorial published in JAMA Pediatrics. Thus, we hope that this recommendation, which is supported by reputable institutions, such as the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Academy of Pediatrics, is taken under serious consideration and adhered to for the health and well-being of our nation’s future generations.”

With this strong recommendation for folic acid supplements, Dr. MacKay said the next logical step would be to include multivitamins with folic acid within all government nutrition programs, including Supplemental Nutrition Assistance Programs (SNAP). “This will ensure that reproductive-age women looking to the government for nutritional assistance will have access to the protective effects of folic acid during pregnancy. Low-income mothers should have the choice to use their SNAP benefits to purchase a multivitamin with folic acid. Furthermore, a multivitamin provides other nutrients, such as iodine, that are critical for a healthy pregnancy.”

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