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Am Fam Physician. 2023;108(3):online

As published by the USPSTF.

What does the USPSTF recommend?Persons who plan to or could become pregnant:
Take a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid.
Grade: A
To whom does the recommendation apply?This recommendation applies to all persons who are planning to or could become pregnant. It does not apply to persons who have had a previous pregnancy affected by neural tube defects or who are at very high risk due to other factors such as family history or those taking medication known to block the function of folic acid.
What's new?This recommendation is consistent with the 2017 USPSTF recommendation.
How to implement this recommendation?All persons who are planning to or could become pregnant should take a daily supplement or multivitamin containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid.
How often?Supplementation should be taken daily. The critical period for folic acid supplementation starts at least 1 month before conception and continues through the first 2 to 3 months of pregnancy.
Nearly half of all pregnancies in the United States are unplanned, meaning that many persons may not know they are pregnant during the crucial time. To gain the full benefits of supplementation, clinicians should advise all persons who plan to or who could become pregnant to take a daily folic acid supplement.
Why are this recommendation and topic important?Neural tube defects are caused by a failure of closure of the embryonic neural tube, which results in birth defects of the brain, spinal cord, and overlying tissues. The most common forms of neural tube defects are anencephaly, encephalocele, and spina bifida.
Neural tube defects are among the most common congenital malformations in the United States, with an estimated 3000 pregnancies affected each year. Neural tube defects can result in death and a range of disabilities affecting children.
Daily supplementation with folic acid is shown to prevent neural tube defects.
What are additional tools and resources?The Community Preventive Services Task Force recommends community-wide education campaigns to promote the use of folic acid supplements among persons of childbearing age (
Where to read the full recommendation statement?Visit the USPSTF website or the JAMA Network website ( to read the full recommendation statement. This includes more details on the rationale of the recommendation, including benefits and harms; supporting evidence; and recommendations of others.

The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

This series is coordinated by Joanna Drowos, DO, contributing editor.

A collection of USPSTF recommendation statements published in AFP is available at

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