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Draft Calls for Folic Acid to Prevent Neural Tube Defects
Task Force Seeks Comments on Updated Recommendation
March 7, 2023, News Staff — Family physicians and others are invited to comment on an updated U.S. Preventive Services Task Force draft recommendation statement and draft evidence review that calls for a daily supplement of 0.4 to 0.8 mg of folic acid for anyone who is or could become pregnant, as a measure to prevent neural tube defects.
Comments on this “A” recommendation will be accepted through 11:59 p.m. ET March 20.
The task force also said that for supplementation to be beneficial, people who are planning to or could become pregnant should take folic acid every day at least one month before anticipated conception, and continue through the first two to three months of pregnancy.
“Neural tube defects can cause serious complications for babies, including disability and death,” said task force member Katrina Donahue, M.D., M.P.H., a professor and vice chair of research in the Department of Family Medicine at the University of North Carolina School of Medicine at Chapel Hill, in a USPSTF bulletin. “Fortunately, taking folic acid before and during early pregnancy can help prevent neural tube defects.”
Neural tube defects are among the most common birth defects in the United States. According to the CDC, the two most common NTDs are spina bifida and anencephaly. Most NTDs are caused by low maternal folate levels; folate occurs naturally in many foods, and a synthetic form called folic acid is available through prenatal vitamins, multivitamins, tablets and as a food additive. Because NTDs happen early in pregnancy, often before a person knows they are pregnant, many agencies in addition to the USPSTF recommend that women of reproductive age take folic acid to help prevent NTDs.
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Previous Findings Confirmed
This draft reaffirms the task force’s 2017 recommendation, which also had an “A” grade.
It should be noted that the draft recommendation does not apply to people who have had a previous pregnancy that was affected by neural tube defects or who are at very high risk because of other factors, such as family history or use of certain antiseizure medications. It also does not apply to people taking certain medications known to block the function of folic acid, including — but not limited to — methotrexate, carbamazepine and valproic acid. The draft recommends that these people talk to their doctor or another clinician if they are planning to or could become pregnant.
The USPSTF found convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid taken in the periconceptional period could reduce the risk for neural tube defects. The task force also found adequate evidence that folic acid supplements taken at their usual doses are not associated with serious harms, and called for additional research on topics such as factors that contribute to variations in supplementation.
“Because many people don’t get enough folic acid in their diets, it’s important that anyone who is planning to or could become pregnant take a daily supplement containing folic acid,” said Wanda Nicholson, M.D., M.P.H., M.B.A., the task force’s vice chair. “The best time to start taking folic acid is at least one month before pregnancy and continuing through the first trimester.”
Resources for Family Physicians
The AAFP supported the 2017 version of the task force’s recommendation statement on folic acid supplementation. The Academy also offers
- a list of maternity care clinical recommendations and guidelines,
- a series of women’s health CME activities and
- an AFP by Topic collection of articles on prenatal care.
The Women’s Preventive Services Initiative, a longstanding Academy partner, has also published several recommendations and resources for family physicians and others who care for patients before, during and after pregnancy.
In addition to the draft recommendation, the USPSTF has a fact sheet for clinicians and patients on folic acid supplementation, and links to a Community Preventive Services Task Force systematic review on the effectiveness of community campaigns to promote folic acid supplementation during pregnancy.