It is possible for women to increase their consumption of dietary folates by careful selection o f foods, but food folates are less well absorbed than synthetic folic acid. Fortification of staple foodstuffs with folic acid is potentially an effective and inexpensive approach to assist women to increase their intake of folic acid. The Food and Drug Administration is currently considering requiring the fortification of enriched cereal grain flours with synthetic folic acid. Although pernicious anemia is rare in women and children, there is concern that folic acid doses exceeding 1.0 mg per day may prevent the diagnosis of this disease, correcting the anemia while the neurological symptoms progress to irreversible deficits. The recommended combination of dietary folates and folic acid supplementation is unlikely to exceed 0.8 mg per day.
Cumulative effects are unlikely since folic acid is water soluble and usually rapidly excreted.
The Food and Drug Administration should require that enriched cereal grain flours are fortified with folic acid. Women with a previous history of NTDs in their families should obtain genetic counseling concerning their recurrence risks, the management of subsequent pregnancies and the appropriate folic acid intake for them. Periconceptional use of multivitamins and the occurrence of NTDs. Miles JL, Rhoads GG, Simpson JL et. The absence of a relationship between the periconceptional use of vitamins and NTDs.