From the Guidelines
Yes, folic acid supplements are recommended to treat low folate levels, with a typical dose of 400-800 μg (0.4-0.8 mg) daily for adults, as supported by the USPSTF recommendation 1. The goal of folic acid supplementation is to prevent neural tube defects and other birth defects, as well as to treat folate deficiency.
- The USPSTF recommends daily folic acid supplementation of 400-800 μg (0.4-0.8 mg) for all reproductive-age women, with high certainty of net benefit and no evidence of harm 1.
- A Cochrane meta-analysis found that higher doses of folate supplementation (>400 μg or >0.4 mg) do not have any additional effect on the prevalence or recurrence of neural tube defects 1.
- The Society of Obstetricians and Gynaecologists of Canada recommends 1 mg folic acid per day for women with a personal history of neural tube defects or other birth defects, or with a family history of these conditions 1.
- It is essential to identify and address any underlying causes of folate deficiency, such as malabsorption disorders, certain medications, or increased requirements during pregnancy, and to perform blood tests after treatment to confirm that folate levels have normalized.
- Other micronutrients, such as thiamine, betaine, riboflavin, vitamin B6, vitamin C, vitamin E, niacin, iron, retinol, vitamin A, and choline, may also have a preventive role in fetal neural tube defects, but more research is needed to support their use 1.
From the FDA Drug Label
Although most patients with malabsorption cannot absorb food folates, they are able to absorb folic acid given orally. The usual therapeutic dosage in adults and children (regardless of age) is up to 1 mg daily. The answer is yes, folic acid is given to supplement low folate levels, with a usual therapeutic dosage of up to 1 mg daily in adults and children, and maintenance levels ranging from 0.1 mg to 0.8 mg per day depending on the patient's age and condition 2.
- The dosage may need to be adjusted based on the patient's response and underlying conditions.
- It is essential to rule out or treat vitamin B12 deficiency before administering high doses of folic acid.
From the Research
Folic Acid Supplementation for Low Folate Levels
- Folic acid is recommended to supplement low folate levels, particularly in women planning a pregnancy and pregnant women in the first trimester, to prevent neural tube defects 3, 4, 5.
- The prevention of neural tube defects with folic acid is evident from meta-analysis, randomized controlled trials, observational studies in humans, and experimental evidence in animals 3.
- Folate supplementation has also been shown to be protective against other adverse birth outcomes, such as congenital heart defects, low birth weight, and preterm birth 3, 6.
- The recommended dose of folic acid for supplementation is 400-800 µg/d, taken at least 2-3 months before conception until the end of the first trimester 3, 4, 5.
Benefits of Folic Acid Supplementation
- Folic acid supplementation can reduce the incidence of neural tube defects by 45% in women who receive 400 micrograms per day 4.
- Elevations in homocysteine levels, a metabolite associated with folate, are reduced by folic acid administration, which may also prevent heart disease, stroke, and peripheral arterial disease 4.
- Folic acid supplementation may also prevent other birth defects, such as congenital heart defects, although the evidence is not yet conclusive 3, 6, 7.
Importance of Folic Acid Supplementation
- Low maternal folate status during pregnancy and lactation remains a significant cause of maternal morbidity in some communities 6.
- Inadequate maternal folate status during pregnancy may lead to low infant birthweight, thereby conferring risk of developmental and long-term adverse health outcomes 6.
- Folic acid supplementation is crucial for reaching target protective plasma folate levels in the population, particularly in elderly people and young women who are at risk for diseases related to folate shortage 5.