Prevention check
Should I take folic acid, and how much?
Folic acid taken before and in early pregnancy lowers the risk of neural tube defects such as spina bifida. The US Preventive Services Task Force recommends it for everyone who could become pregnant. Check what applies to you.
About you
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What you will see
Whether the USPSTF folic acid advice covers you, the dose and when to start.
Educational only, not medical advice. Talk to a clinician about supplements.
Source
US Preventive Services Task Force, August 2023 reaffirmation recommendation on folic acid supplementation to prevent neural tube defects.
Validated in
People who are planning to or could become pregnant.
Limits
It does not set a dose for people at very high risk (a previous affected pregnancy, family history, or medicines that interfere with folic acid); they need a clinician's advice.
What the USPSTF recommends
| Who | Recommendation | Grade |
|---|---|---|
| Everyone planning to or who could become pregnant | Take a daily supplement with 0.4 to 0.8 mg (400 to 800 mcg) of folic acid, from at least 1 month before conception through the first 2 to 3 months of pregnancy | A |
The 2023 statement reaffirms the 2017 recommendation (USPSTF 2023). A multivitamin with folic acid counts; the generally available dose is 0.4 mg (400 mcg) (USPSTF 2023).
Why timing matters
The neural tube usually closes 26 to 28 days after fertilization, and many people do not yet know they are pregnant during this time. That is why the critical period starts at least 1 month before conception (USPSTF 2023). Nearly half of US pregnancies are unplanned, so the advice covers everyone who could become pregnant, not only people who are trying (USPSTF 2023).
Why it matters
Neural tube defects are among the most common birth defects in the US, affecting an estimated 3,000 pregnancies a year. Spina bifida occurs in about 3.9 and anencephaly in 2.5 of every 10,000 live births (USPSTF 2023). Many are caused by low folate in the pregnant person (USPSTF 2023). Food in the US has been fortified with folic acid since 1998, but people who may become pregnant do not eat enough fortified food to get the full benefit, and only about 20% to 40% of women who were recently pregnant or trying reported taking supplements (USPSTF 2023).
Who is at higher risk
All pregnancies are at risk. Higher risk comes with a personal, partner or family history of neural tube defects, malabsorption after bariatric surgery, certain antiseizure medicines and gene variants in folate enzymes; people with these should talk to their clinician. Diabetes before pregnancy and obesity are also associated with higher risk (USPSTF 2023). The recommendation does not apply to people with a previous affected pregnancy, very high risk, or medicines that block folic acid such as methotrexate, carbamazepine and valproic acid (USPSTF 2023).
Common questions
Is folic acid safe?
The USPSTF found that folic acid at usual doses is not linked to serious harms. Studies since 2017 found no link between supplements and a higher risk of autism (USPSTF 2023).
What about men?
The recommendation is for people who could become pregnant. A partner's history of neural tube defects is still worth telling your clinician (USPSTF 2023).
Also see the iron deficiency in pregnancy check, the preeclampsia risk and aspirin check, the gestational diabetes screening check, the quit smoking help check and all screening tests by age.
Sources
- 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. www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-10-30. Spotted an error? See About.