Folic acid supplementation must for women before and during pregnancy: USPSTF final recommendation

In the US, neural tube defects are among the most common congenital malformations. About 3000 pregnant women are affected by it each year. Many of these neural tube defects are caused by low folate levels in the body.

In its reaffirmation recommendation statement, published in JAMA (Journal of the American Medical Association), USPSTF recommends folic acid supplementation for people planning to or who could become pregnant.

The document stated, "All women who are planning to or could become pregnant should take a daily folic acid supplementation of 0.4 to 0.8 mg to prevent neural tube defects." (A recommendation).

“The task force continues to underscore the importance of taking a daily supplement containing folic acid before and during early pregnancy to help protect the health of babies,” USPSTF member Katrina Donahue, MD, MPH, said in a press release. “By taking folic acid, people can reduce the risk of developing neural tube defects, which can result in serious complications for babies including disability and death.”

In 2017, the USPSTF reviewed the evidence for folic acid supplementation and issued an A recommendation. The USPSTF decided to use a process of reaffirmation deliberation to update this recommendation. The reaffirmation process is used by the task force for well-established, evidence-based current standards of practice in primary care for which only a very high level of evidence would justify a change in the grade of the recommendation.

In its deliberation of the evidence, the USPSTF considers whether the new evidence is of sufficient quality and strength to change its previous conclusions about the evidence.

Using a reaffirmation process, the USPSTF concludes that, for people who are planning to or could become pregnant, there is high certainty that folic acid supplementation has a substantial net benefit.

The recommendation is based on a systematic review of the new evidence on the benefits and harms of folic acid supplementation for the prevention of neural tube defects. The researchers examined data from 12 observational studies reported in 13 publications, with 1,244,072 participants.

Meera Viswanathan, RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, and colleagues found that one cohort study reported a significantly reduced risk for neural tube defects associated with folic acid supplementation taken before, during, and before and during pregnancy (adjusted relative risks, 0.54, 0.62, and 0.49, respectively); this association was seen in the later of two study periods (2006 to 2013 but not 1999 to 2005). No other significant benefits were reported. There were no reports of significant harm associated with pregnancy-related folic acid exposure.

The recommendation applies only to people who are planning to or could become pregnant. It does not apply to people with a previous pregnancy affected by neural tube defects or who are at very high risk because of other factors (eg, use of certain antiseizure medications or family history). Also, it does not apply to people taking certain medications known to block folic acid function (eg, valproic acid, carbamazepine, and methotrexate).

Reference:

US Preventive Services Task Force. Folic Acid Supplementation to Prevent Neural Tube Defects: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2023;330(5):454–459. doi:10.1001/jama.2023.12876