Based on evidence that folic acid (FA) therapy could reduce the occurrence and recurrence of neural tube defects (NTDs) in pregnant women, the United States Food and Drug Administration mandated the addition of FA to all “enriched” cereal-grain products. Further, women of childbearing potential should consume a supplement containing 400 mcg of FA daily. Rates of births affected by NTDs have decreased since the advent of FA fortification. FA fortification also may have a benefit on the development of vascular disease, other birth defects, and cognitive decline. Concerns have been raised that FA fortification might mask or exacerbate the consequences of vitamin B12 deficiency, promote cancer through epigenetic hypermethylation, or interfere with antifolate treatment. However, there is no evidence to date that foods fortified with FA cause harm. More research is required to examine the safety of FA fortification more thoroughly, but clinicians should exert every effort to communicate the need for women of childbearing age to consume at least 400 mcg/day of FA.

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