All Women of Childbearing Age Should Take Daily Folic Acid Supplement

Any woman capable of becoming pregnant should consider taking a daily supplement of folic acid, according to draft guidelines from the US Preventive Services Task Force (USPSTF).

The USPSTF will issue final recommendations after the public comment period on these draft guidelines ends on June 6, 2016. For now, the task force is leaning toward recommending that all women who may become pregnant should take 0.4 mg to 0.8 mg of folic acid each day in order to prevent neural tube defects.

Neural tube defects develop early in pregnancy and can lead to fetal disability or death. The most common defects are anencephaly and spina bifida, which are estimated to occur in 6.5 cases per 10,000 live births, based on 2009 to 2011 data.

“Folic acid supplementation in the periconceptional period is a primary prevention intervention that can be implemented in primary care settings to prevent neural tube defects,” the draft recommendation stated.

The USPSTF found convincing evidence that folic acid supplementation could reduce patients’ risk of neural tube defects in the developing fetus. One estimate suggested that about 1300 annual births affected by neural tube defects could have been prevented by folic acid supplementation.

While family history or personal history may increase the risk of birth defects, most cases occur without any past history of neural tube defects.

The USPSTF noted that these recommendations don’t apply to women who have already experienced a pregnancy where neural tube defects were an issue, because these women need special management.

Other risk factors include antiseizure medications like valproic acid or carbamazepine, mutations in the folate-related enzymes, maternal diabetes, and obesity. In addition, Hispanic women may be more likely to encounter neural tube defects than white or African-American women. One reason for this is that Mexican-American women may eat less fortified food and more corn-based diets.

However, the FDA recently approved folic acid fortification of corn masa flour in April 2016, so this could potentially lower the higher rates of defects among pregnant Mexican-American women.

The USPSTF noted that most women have a hard time getting enough folic acid through food alone.

One reason why the USPSTF draft recommendations extends to all women capable of getting pregnant and not just women planning to become pregnant is because half of all pregnancies in the United States are unplanned.

Nurse practitioners and physician assistants working in retail clinics can inform their female patients that the most critical time for supplementation is 1 month before conception and through the first 2 to 3 months of pregnancy.

The USPSTF didn’t find any evidence that supplementation could lead to serious harm.

In one study it examined, there were potential increased risks for weight gain, diarrhea, and constipation at 12 weeks of pregnancy, but the event rate was low and these effects could have happened by chance. The USPSTF also noted that these symptoms are linked to pregnancy.