Folic Acid Recommendations
All women of reproductive age should get 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent neural tube defects (NTDs). NTDs are major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).
The CDC, Institute of Medicine, and U.S. Preventive Services Task Force all recommend that women of reproductive age take folic acid to help prevent NTDs.
- Read more about CDC’s folic acid recommendations
- Read more about the Institute of Medicine’s folic acid recommendations
- Read more about the U.S. Preventive Services Task Force’s folic acid recommendations: An update for this topic is in progress.
Women who have already had an NTD-affected pregnancy and are planning to become pregnant again should consult with their healthcare provider. The current recommendations are that these women consume 4,000 mcg of folic acid each day beginning 1 month before becoming pregnant and through the first 3 months of pregnancy.
When not planning to become pregnant, women who have had an NTD-affected pregnancy should consume 400 mcg of folic acid each day.
- The recommendation to take a higher dose of folic acid is based on data from the most rigorous scientific study involving women who had previous NTD-affected pregnancies. Dosages lower than 4,000 mcg have not been studied in women who have had a previous NTD-affected pregnancy.
History of folic acid recommendations in the United States
This documentary short chronicles the hard work behind folic acid fortification in the United States and its positive effects on the health and well-being of so many children and families.
Researchers have studied the association between low folate levels in women and neural tube defects as early as 1965.1 Neural tube defects are major birth defects of a baby’s brain (anencephaly) and spine (spina bifida). A number of studies showed that taking folic acid before and during the first weeks of pregnancy helped to lower the chance of neural tube defects.1
CDC recommended that women who had a pregnancy affected by a neural tube defect consume folic acid before planning to become pregnant again.2
The U.S. Public Health Service recommended that all women who could become pregnant get 400 micrograms (mcg) of folic acid each day to prevent neural tube defects.3
The Institute of Medicine’s Food and Nutrition Board of the National Academy of Sciences recommended that all women who can become pregnant get 400 mcg of folic acid each day, in addition to consuming food with folate from a varied diet, to reduce the risk of neural tube defects.4
The U.S. Food and Drug Administration (FDA) required that manufacturers add folic acid to cereal grain products labeled as ‘enriched’ to lower the chance of neural tube defects from occurring. This is mandatory fortification.5
- Mandatory fortification is the most effective public health strategy to help prevent neural tube defects because
- Almost half of all pregnancies are unplanned;6
- Folic acid is only effective before and during the first weeks of pregnancy, often before a woman knows she is pregnant; and
- It is not necessary to remember to take a vitamin each day before becoming pregnant.
Hispanic/Latina women are more likely to have a child born with a neural tube defect compared to non-Hispanic white and non-Hispanic black women and lower median total folic acid (FA) intake.5-7 To address this health disparity and help more women get the recommended daily value of folic acid each day, the FDA allowed folic acid to be added voluntarily to corn masa flour. This is voluntary fortification. Adding folic acid to corn masa flour will
- Increase the average amount of daily folic acid women get;
- Help more women, specifically Hispanics/Latinas, get the recommended daily value of folic acid;8 and
- Prevent an estimated 40 (range of 0-120) additional Hispanic infants per year from being born with an NTD.9
Data from 2017-2018 have shown that voluntary fortification with folic acid has not yet had an impact on the folate status among Hispanic women of reproductive age in the United States.10 It is important to check the nutrition label on food packaging to see if it contains folic acid, as corn masa flours may or may not contain folic acid.
For more information, visit the Frequently Asked Questions page.
You can also contact CDC-INFO in English or Spanish:
- Crider KS, Bailey LB, Berry RJ. Folic acid food fortification–its history, effect, concerns, and future directions. Nutrients. 2011;3(3):370–384.
- Centers for Disease Control and Prevention (CDC). Use of folic acid for prevention of spina bifida and other neural tube defects–1983–1991. MMWR Morb Mortal Wkly Rep. 1991;40(30):513–516.
- Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep. 1992;41(RR-14):1–7.
- Institute of Medicine (US). Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington (DC): National Academies Press (US); 1998.
- Williams J, Mai CT, Mulinare J, et al. Updated estimates of neural tube defects prevented by mandatory folic acid fortification – United States, 1995–2011. MMWR Morb Mortal Wkly Rep. 2015;64(1):1–5.
- Centers for Disease Control and Prevention (CDC). Racial/ethnic differences in the birth prevalence of spina bifida – United States, 1995–2005. MMWR Morb Mortal Wkly Rep. 2009;57(53):1409–1413.
- Canfield MA, Mai CT, Wang Y, et al. The association between race/ethnicity and major birth defects in the United States, 1999–2007. Am J Public Health. 2014;104(9):e14–23.
- Flores AL, Cordero AM, Dunn M, et al. Adding folic acid to corn masa flour: Partnering to improve pregnancy outcomes and reduce health disparities. Prev Med. 2018;106:26–30.
- Tinker SC, Devine O, Mai C, et al. Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. Birth Defects Research A Clin Mol Teratol. 2013;97(10):649–657.
- Wang A, Rose CE, Qi YP, Williams JL, Pfeiffer CM, Crider KS. Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018). Nutrients. 2021, 13(4), 1325; https://doi.org/10.3390/nu13041325.