Provider Alerts

Facility Site Review (FSR) Update

Calendar Year 2025

Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication

The U.S. Preventive Services Task Force (USPSTF) is a scientifically independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services.

The USPSTF recommends that all individuals planning to or who could become

pregnant take a daily supplement of 0.4 to 0.8 mg (400 to 800 mcg) of folic

acid, starting at least one month before conception and continuing through the first two to three months of pregnancy.

USPSTF and World Health Organization (WHO) categorize women in the age range of 12-49 years as “women who are capable of becoming pregnant”.

Key Recommendations:

1. Rationale for universal prophylaxis in females of childbearing potential: Major national medical organizations and public health authorities recommend that allfemales of childbearing potential, not just those who are attempting to conceive, receive a daily folic acid supplement. This broad recommendation is based on:

• The need for adequate folate/folic acid intake very early in pregnancy when the neural tube is developing (closure of the neural tube occurs 26 to 28 days after conception [i.e., by 6 weeks of gestation].
• The potential for inadequate intake at this time because a large number of pregnancies are unplanned in the United States.
• Even if the pregnancy is planned, many individuals do not know that they are pregnant this early in gestation and thus may not start taking a supplement before closure of the neural tube.
• Furthermore, many individuals are initially seen for prenatal care later in the first trimester and thus may not receive information about or a prescription for folic acid supplementation during the critical period of neural tube development.

2. Dosage: The recommended daily dosage of folic acid is between 0.4 mg and 0.8 mg (400 to 800 mcg). This supplementation is crucial for preventing neural tube defects, which are serious birth defects of the brain and spine.
3. Timing: It is essential to start taking folic acid at least one month before conception and to continue through the first two to three months of pregnancy. This timing is critical because many pregnancies are unplanned, and the early weeks are vital for fetal development.
4. Importance of Supplementation: Folic acid supplementation significantly reduces the risk of neural tube defects, which can lead to severe disabilities or death. The USPSTF emphasizes that nearly 3,000 pregnancies in the U.S. are affected by these defects each year, making this recommendation particularly important for public health.
5. Additional Considerations: Women with a personal or family history of neural tube defects, those taking specific medications (like certain antiseizure drugs), or those with conditions such as diabetes or obesity may require higher doses of folic acid. These individuals should consult their healthcare provider for personalized recommendations.

By following these guidelines, individuals can help ensure better health outcomes for      themselves and their future children. For more detailed information, you can refer to the official USPSTF recommendation statement in the link below.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication

Documentation recommendations for medical record review compliance:

1. Progress notes should include counselling regarding the benefits of folic acid supplementation.
2. People who are not planning on becoming pregnant, including those who are using any form of contraceptives or staying single, should still receive counselling and be given a prescription of folic acid.
3. History of tubal ligation, hysterectomy, diagnosis of infertility, or any condition that prevents her from becoming pregnant should be recorded in the progress notes.
4. The recommendation also applies to members whose assigned sex at birth is female and retained the biological traits of a woman and can become pregnant.
5. Any patient refusal should be documented in the patient’s chart.
6. Below is a table of approved National Drug Code (NDC) List for folic acid supplements to assist in prescribing.

References:

Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication#fullrecommendationstart

Final Recommendation Statement

Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication

Folic Acid Supplementation for the Prevention of Neural Tube Defects: Recommendation Statement:

https://www.aafp.org/pubs/afp/issues/2017/0515/od4.html

For Inquiries on the Department of Health Care Services Medical Record Review (DHCS MRR) requirement regarding the Folic Acid Supplementation can be sent to fsrteam@hpsj.com.

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org