So why not give all pregnant women 4mg folic acid daily?

[MedicineZ0Z]

Pregnant or women wanting to become pregnant, regardless of medical history - why not give them all 4mg/day? As far as I know there's loose evidence that it may have some benefits but most importantly, what's the harm?

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[Dr G Oogle]

No harm; but for it to be effective you have to take it at least 4 weeks before conception. A very significant portion of pregnancies are unintended and therefore those cannot be given folic acid for it to be effective. The majority of people who come for preconception counseling are usually started on folic acid. Dose depends on whether or not they’re at higher risk of NTD

 

[MedicineZ0Z]

No harm; but for it to be effective you have to take it at least 4 weeks before conception. A very significant portion of pregnancies are unintended and therefore those cannot be given folic acid for it to be effective. The majority of people who come for preconception counseling are usually started on folic acid. Dose depends on whether or not they’re at higher risk of NTD

True, but can't we just start everyone on 4mg regardless of NTD risk?

 

[Dr G Oogle]

Sure, there’s a already a recommendation that anyone considering pregnancy should take a daily folate supplement Office of Dietary Supplements - Folate

Short of putting it in the water supply can’t really force people to take it

 

[tr]

Of course there is a down side. There's always a down side. It's just not as well publicized as the up side.

In the case of excess folic acid intake, possible adverse outcomes include B12 deficiency, immune suppression, and a laundry list of other issues in people with particular genetic susceptibilities.

Excessive folic acid intake and relation to adverse health outcome

The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on earl…

www.sciencedirect.com

Selhub et Al, Excessive folic acid intake and relation to adverse health outcome

 

[MedicineZ0Z]

Of course there is a down side. There's always a down side. It's just not as well publicized as the up side.

In the case of excess folic acid intake, possible adverse outcomes include B12 deficiency, immune suppression, and a laundry list of other issues in people with particular genetic susceptibilities.

Excessive folic acid intake and relation to adverse health outcome

The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on earl…

www.sciencedirect.com

Selhub et Al, Excessive folic acid intake and relation to adverse health outcome

I loosely remember that higher folic acid levels seem to be tied to higher IQ levels as well. B12 deficiency makes sense though you can always add on a little in supplement form too.
Perhaps from a physician perspective counseling individual patients, maybe going with a medium dose range is ideal?