Potential Adverse Effects of Folic Acid

Folate is not associated with any toxicity symptoms [7]. However, because of a potential concern that high doses of supplemental folic acid may interfere with the diagnosis of a vitamin B12 deficiency (referred to as "masking"), the IOM recommends the total daily intake of folic acid should not exceed 1,000mcg (1 mg) unless prescribed by a physician. Recent evidence indicated that folic acid fortification has not lead to an increase in masking of vitamin B12 deficiency [30]. However, health care practitioners prescribing prenatal vitamins containing 1 mg folic acid should monitor vitamin B12 status, especially if folic acid fortified foods are consumed in addition to the supplement. Although vitamin B12 deficiency is not a common finding among women of childbearing age, women who avoid animal-based foods, the sole source of vitamin B12, should be advised to take supplemental vitamin B12.

During pregnancy, over-the-counter (OTC) multivitamin supplements that contain lower levels of folic acid intended for nonpregnant women should not be taken without the knowledge and approval of health care providers. Many OTC supplements contain retinol that could be harmful to a developing embryo [31].

Several reports have suggested the possibility of a significant increase in the occurrence of miscarriage or multiple births associated with folic acid supplementation. As recently reviewed, research evidence does not support these suggestions [23].

Health care providers can be confident that by encouraging nonpregnant women of childbearing age to take folic acid supplements and pregnant women to take prenatal vitamins with folic acid that they are significantly improving pregnancy outcomes without increasing risks.

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