Folic Acid - A review of the Systematic Review

supplementation Sep 28, 2022
A closer look at folic acid and pregnancy

Our co-founder reviews a recently published Systematic Review which included 36 studies. The aim of the review was to assess whether women who are taking folic acid supplements PLUS consuming folic acid fortified foods might be exceeding the upper tolerable limit. 

It is recommend that women of reproductive age and pregnant women consume 400 mcg of folic acid per day via a supplement to prevent neural tube defects in their offspring. In Australia, mandatory fortification of mainly grain products like breads and cereals started in 2009 as a public health initiative to prevent neural tube defects in women who may not have access to supplementation or in vulnerable populations were folate intake was low. The problem the review highlights is that while one study reported only 63% of women took a folic acid supplement 3 month prior to pregnancy and another study found that women only consuming food sources of folate, 80% didn’t meet the daily requirement, the combination of both supplement and fortified foods may be problematic. The review found that many women in the preconception phase and almost all pregnant women who consumed a combination of folic acid supplementation PLUS folic acid fortified foods were exceeding the daily upper limit for folic acid, putting them at rick of unmetabolised folic acid AND had the potential to mask B12 deficiency. 

The take home messages:

  • Know that you can get too much folic acid, but natural folate found in wholefoods is safe. 
  • Keep taking your 400 mcg of folic acid in preconception and pregnancy as a supplement, this is based on the best available evidence for NTD risk reduction.
  • Be mindful of how many serves of cereals and grain products you are consuming that are folic acid fortified. Most contain 200mcg of 100g of wheat flour. 
  • There is no issue with unmetabolised folic acid with natural folates which are found in leaf greens, legumes, citrus food etc. So, please keep eating an abundance of these. 
  • If unsure, personalised dietary counselling or assessment is advised.
  • This review provides evidence that mandatory food fortification may need to be reconsidered at a public health level.


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