Women's Health

Folic Acid

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  • Reduces the risk of neural tube defects, especially in the first month of pregnancy

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Why we recommend

Folic acid supplementation, especially during the first month of pregnancy leads to a drastic reduction in neural tube defects.

A systematic review by de Regil found that across 5 studies involving 6708 births, folate or folic acid supplementation resulted in drastically lower rates of neural tube defects.1

Unfortunately, the benefits of folate or folic acid are most important during the first month of pregnancies. Often it takes a month or longer before learning that you are pregnant (50% of pregnancies are unplanned). As a result, the US Preventive Services Task Force recommends folic acid supplementation (400-800 mcg) for women who might bear a child, and supplementation should continue from 1 month prior to pregnancy through the 2nd or 3rd month of pregnancy.2

Research benefits

Neural tube birth defects
Drastic reduction in birth defects
Highlights:

Drastic reduction in neural tube defects. Not enough information for other defects.

Source: De Regil, 2015 (1).

Mortality
No impact
Highlights:

Source: US Preventive Services Task Force, 2018 (2).

Any Cancer
Risk of cancer increase
Highlights:

Among people with non-cancerous tumors, there was a statistically significant increase in the odds of cancer.

Other reviews conflict on whether folic acid increases cancer. A review by Wien et al finds a statistically significant association with cancer. Another review by Vollset et al shows no increase in cancer.

Source: US Preventive Services Task Force, 2018 (2). Wien, 2012 (5). Vollset, 2013 (6).

Harms
Risk of cancer increase
Highlights:

Potential risk of cancer increase from over-supplementation of folic acid. Cancer is also associated with low levels of folate (4). See discussion under cancer Impact.

Source: US Preventive Services Task Force, 2018 (2). Field, 2018 (4). Wien, 2012 (5). Vollset, 2013 (6).

References

  1. De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD007950. DOI: 10.1002/14651858.CD007950.pub3.
  2. O’Connor EA, Evans CV, Ivlev I, et al. Vitamin, Mineral, and Multivitamin Supplementation for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Jun. (Evidence Synthesis, No. 209.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK581642/
  3. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Folic acid supplementation for the prevention of neural tube defects: US Preventive Services Task Force recommendation statement. JAMA 2017;317:183-9
  4. Field, M.S. and Stover, P.J. (2018), Safety of folic acid. Ann. N.Y. Acad. Sci., 1414: 59-71. https://doi.org/10.1111/nyas.13499
  5. Wien TN, Pike E, Wisløff T, et al, Cancer risk with folic acid supplements: a systematic review and meta-analysis, BMJ Open 2012; e000653. doi: 10.1136/bmjopen-2011-000653
  6. Vollset SE, Clarke R, Lewington S, Ebbing M, Halsey J, Lonn E, Armitage J, Manson JE, Hankey GJ, Spence JD, Galan P, Bønaa KH, Jamison R, Gaziano JM, Guarino P, Baron JA, Logan RF, Giovannucci EL, den Heijer M, Ueland PM, Bennett D, Collins R, Peto R; B-Vitamin Treatment Trialists' Collaboration. Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50,000 individuals. Lancet. 2013 Mar 23;381(9871):1029-36. doi: 10.1016/S0140-6736(12)62001-7. PMID: 23352552; PMCID: PMC3836669.
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