What is the recommended daily intake of folate (folic acid) during pregnancy?

From the Guidelines

The recommended daily intake of folate (folic acid) during pregnancy is 400 μg (0.4 mg) for all women of child-bearing age, with higher doses of 4,000 μg (4 mg) recommended for high-risk women. Pregnant women should begin taking a prenatal vitamin containing at least 400 μg of folic acid before conception and continue throughout the first trimester, as this supplementation is advised in addition to consumption of folic acid fortified food 1. Adequate folate intake is crucial during early pregnancy, particularly in the first trimester, as it helps prevent serious birth defects like spina bifida and anencephaly. Some key points to consider include:

• High-risk women, defined as those with a personal, family, or prior pregnancy history of neural tube defects, type 1 diabetes mellitus, or exposure to high-risk medications during early pregnancy, should take a higher dose of 4,000 μg (4 mg) of daily folic acid supplementation at least 12 weeks prior to conception 1.
• The American College of Medical Genetics and Genomics recommends that all women of child-bearing age consume a daily folic acid intake of 400 μg (0.4 mg) to reduce the risk of neural tube defects 1.
• A study published in the Annals of Internal Medicine found that supplementation with 0.4 to 0.8 mg (400 to 800 μg) of folic acid in the periconceptional period reduces the risk for neural tube defects in offspring 1.
• Another study published in the American Family Physician found that folic acid supplementation of 400 mcg daily started before pregnancy and continued until six to 12 weeks postconception reduces the rate of neural tube defects by nearly 75% 1. Good dietary sources of folate include leafy green vegetables, citrus fruits, beans, and fortified grains, which can complement supplementation. Since many pregnancies are unplanned, health authorities recommend that all women of childbearing age consume sufficient folate. It is essential to note that while folic acid supplementation can significantly reduce the risk of neural tube defects, some fetal neural tube defects are of multifactorial or monogenic etiology and cannot be completely prevented 1.

From the FDA Drug Label

The usual therapeutic dosage in adults and children (regardless of age) is up to 1 mg daily... 0.8 mg for pregnant and lactating women, but never less than 0. 1 mg/day. The recommended daily intake of folate (folic acid) during pregnancy is 0.8 mg 2.

• The daily dose should not be less than 0.1 mg.
• Doses greater than 1 mg do not enhance the hematologic effect.

From the Research

Folate Intake During Pregnancy

The recommended daily intake of folate during pregnancy varies based on the individual's risk factors.

• Women with a low risk for neural tube defects or other folic acid-sensitive congenital anomalies require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues 3.
• Women with a moderate risk for neural tube defects or other folic acid-sensitive congenital anomalies require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception 3.
• Women with a high risk for neural tube defects, a male partner with a personal history of neural tube defect, or history of a previous neural tube defect pregnancy in either partner require a diet of folate-rich foods and a daily oral supplement with 4.0 mg folic acid for at least 3 months before conception and until 12 weeks' gestational age 3.

General Recommendations

• The American Academy of Pediatrics recommends that all women capable of becoming pregnant consume 400 micrograms of folic acid daily to prevent neural tube defects 4.
• The Department of Health advises all women considering pregnancy to take folate supplements for 12 weeks prior to conception and in the first trimester of pregnancy 5.
• The recommended intakes are 4 mg/d for those at high risk and 0.4 mg/d for all others 6.

Key Findings

• Folic acid supplementation can prevent 50% or more of neural tube defects such as spina bifida and anencephaly 4.
• A reduction in NTD births did not follow promulgation of these recommendations, and so folic acid fortification was mandated in the United States and some other countries 6.
• The folate-NTD relation represents the only instance in which a congenital malformation can be prevented simply and consistently 6.