{ "release_id": "fc5a600ec7387e71", "id": "maternal:folic-acid-supplementation", "owner": "maternal", "kind": "intervention", "slug": "folic-acid-supplementation", "name": "Folic acid supplementation before and in early pregnancy", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "Folic acid is a B vitamin. Taking it every day before and in early pregnancy lowers the chance that a baby is born with a neural tube defect, a serious birth defect of the brain or spine. US guidance advises everyone who is planning a pregnancy, or who could become pregnant, to take a daily supplement containing 0.4 to 0.8 mg (400 to 800 micrograms) of folic acid. MedlinePlus says that getting enough folic acid before and during pregnancy can prevent major birth defects of the baby’s brain or spine.", "summary_technical": "USPSTF 2023 reaffirmation: daily 0.4 to 0.8 mg of folic acid, an A recommendation, for persons who are planning to or could become pregnant. The MRC Vitamin Study (1991) is the randomised trial behind the advice for women who had a previous affected pregnancy; its abstract does not give the dose. The USPSTF evidence update found no statistically significant harms for multiple gestation, autism or maternal cancer in the studies it reviewed. These sources do not cover higher-dose advice for people at higher risk.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "preconception", "pregnancy" ], "care-area": [ "preconception-health" ] } }, "payload": { "subtype": "medicine", "mechanism": null, "components": null }, "content_digest": "353701bf3e1017d97b2a23b149428c541f975849842fe4c4cad3172a54f48b5d", "review": { "content_digest": "353701bf3e1017d97b2a23b149428c541f975849842fe4c4cad3172a54f48b5d", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "fc5a600ec7387e71", "id": "maternal:claim-mrc-ntd-recurrence", "owner": "maternal", "subject_entity_id": "maternal:folic-acid-supplementation", "category": "effect", "statement": "In the MRC Vitamin Study, a randomised double-blind trial with a factorial design at 33 centres in seven countries, women at high risk of a pregnancy with a neural tube defect (because of a previous affected pregnancy) were given folic acid, a mixture of seven other vitamins, both, or neither. Of 1195 completed pregnancies in which the fetus or infant was known to have or not have a neural tube defect, 27 had a neural tube defect: 6 in the folic acid groups and 21 in the two other groups. The authors report a 72% protective effect (relative risk 0.28, 95% confidence interval 0.12 to 0.71). The other vitamins showed no significant protective effect (relative risk 0.80, 95% CI 0.32 to 1.72). The abstract reports no demonstrable harm from folic acid, with limited ability to detect rare or slight adverse effects.", "context": { "id": "maternal:ctx-mrc-pregnancies-after-a-neural-tube-defect", "label": "Pregnancies of women with a previous neural tube defect pregnancy (MRC Vitamin Study)", "recipient": "fetal", "population": "Fetuses and infants of women at high risk of a pregnancy with a neural tube defect because of a previous affected pregnancy. 1817 women were allocated at random; 1195 had a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect. The women took the supplement; the outcome is counted in the fetus or infant.", "care_setting": "33 centres in seven countries; the abstract does not name the countries or describe the settings.", "geography": "Seven countries; the abstract does not name them.", "life_stage_note": "Supplementation around the time of conception; outcome at the end of the pregnancy", "life_stage_terms": { "maternal": [ "preconception", "pregnancy" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Until a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect", "eligibility": { "inclusion": [ "Women at high risk of a pregnancy with a neural tube defect because of a previous affected pregnancy" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "Only the PubMed abstract was read. It does not give the folic acid dose, the numbers of women in each group, or the names of the countries. The counts pool the groups that received folic acid (alone or with other vitamins) against the groups that did not, so per-group denominators are not available and are not computed. The result is for women with a previous affected pregnancy; it does not by itself show the size of the benefit for women without one. 1817 women were allocated at random and 1195 are in the pregnancies the abstract counts.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, sentence 3", "applicability_note": "PubMed abstract of the MRC Vitamin Study report (Lancet 1991).", "snapshot": { "id": "maternal:pubmed-1677062-2026-10-14", "retrieved_at": "2026-10-14T18:18:20Z", "content_hash": "35b6b28be5184c6f9e902c7e02db97769b18f69f757aca52b0fa615917cd5af2", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-1677062", "source_type": "publication", "title": "Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. 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No study reported statistically significant harms (multiple gestation, autism and maternal cancer) associated with pregnancy-related folic acid exposure.", "context": { "id": "maternal:ctx-uspstf-2023-evidence-update-studies-in-very-highly-developed-countries", "label": "Pregnant persons and offspring in the studies of the USPSTF 2023 folic acid evidence update", "recipient": "mixed", "population": "Pregnant persons and their offspring in the 9 studies of the USPSTF 2023 evidence update that were eligible for harms: 1 randomized trial (n = 431) and 8 observational studies (7 with n = 761 125 and 1 with n = 429 004). The update looked for randomized and nonrandomized cohort studies in very highly developed countries. Harms were reported for multiple gestation, autism spectrum disorder and maternal cancer, so the context covers mothers and offspring and is not split by recipient.", "care_setting": "Randomized and nonrandomized cohort studies in very highly developed countries (the review inclusion rule); the abstract does not describe settings.", "geography": "Very highly developed countries (review inclusion rule); countries are not named in the abstract.", "life_stage_note": "Pregnancy-related folic acid exposure and offspring outcomes", "life_stage_terms": { "maternal": [ "preconception", "pregnancy", "newborn" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not stated in the PubMed abstract", "eligibility": { "inclusion": [ "Studies eligible for harms of folic acid supplementation, searched July 1, 2015 through July 2, 2021, with surveillance through February 10, 2023" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "limitations": "Finding no statistically significant harm is not proof that there is none. The abstract gives no effect sizes for the harms. The update searched July 1, 2015 through July 2, 2021 (with surveillance through February 10, 2023), reviewed English-language studies in very highly developed countries, and was a limited update that did not repeat the whole earlier review. 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