ACOG guidance provides the latest update on neural tube defects (NTDs) including recommendations related to screening, management and delivery. The USPSTF has reaffirmed its recommendation that folic acid supplementation prevents NTDs in offspring. Evidence of potential harms to mother or infant is no greater than small.
All women who are planning or capable of pregnancy should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid
Approximately 50% of pregnancies in the US are unplanned so it is best to already be on folic acid prior to pregnancy
Daily folic acid intake of 400 µg (0.4 mg) is recommended in all women of child-bearing age
If planning pregnancy, start at least 4 weeks prior to planned conception
Women at High risk: 4,000 µg (4 mg) of daily folic acid supplementation at least 12 weeks prior to conception
Then continue with 400 µg (0.4 mg) after 12 weeks gestation
Note: ACMG highlights that folic acid supplementation reduces risk but not entirely prevent NTDs even among women who are fully compliant
ACOG, CDC, AAFP, AAP, Health and Medicine Division of the National Academies (formerly the Institute of Medicine), US Public Health Service, American Academy of Neurology
Women who are capable of becoming pregnant should take at least 0.4 mg (400 µg) of folic acid daily
ACOG, CDC, and several other organizations
Women with a history of neural tube defects, or has a partner with an NTD or a partner who has had a child with an NTD or other high-risk factors take 4 mg (4000 μg) of folic acid daily
Note: While USPSTF focuses on prevention of NTD, other organizations also stress the prevention of other birth defects such as heart defects, urinary tract anomalies and oral facial clefts
High risk factors include the following
Patient has a previously NTD-affected pregnancy
Patient herself is affected
Patient with a first- or second-degree relative with a NTD
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