Folate Deficiency Follow-up

Updated: Nov 03, 2020
  • Author: Katherine Coffey-Vega, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Patients whose folic acid deficiency is related to dietary factors should be counseled to include green vegetables and fruit in their diet.

Prophylactic treatment of pregnant patients and patients with chronic hemolytic anemias can prevent folic acid deficiency due to the increased requirement for folate in these conditions. Because major teratogenic effects from folate deficiency occur 3-4 weeks after conception and many pregnancies are unplanned, women of reproductive age should ensure that they are receiving 400 μg daily, in addition to consuming food with folate from a varied diet. The US Centers for Disease Prevention recommends that women who have had a pregnancy affected by a neural tube defect consume 4,000 μg of folic acid each day 1 month before becoming pregnant and through the first 3 months of pregnancy. [2]  


Patient Education

Educate patients regarding proper nutrition, including eating fruits and vegetables. Educate patients regarding the need to reduce alcohol ingestion. Discuss the need to take folic acid supplementation. For patient education information, see the Folic Acid Directory.

Medical/legal pitfalls

Failure to provide folic acid supplementation to pregnant females may lead to spontaneous abortion and fetal abnormalities, including neural tube defects and increased risk of severe language delay in the child.

Providing only folic acid supplementation to a patient who has cobalamin deficiency may lead to development of irreversible neuropathies.

No randomized clinical trial has proven the efficacy of lowering the homocysteine concentration to improve cognition or to lower the incidence of cardiovascular disease (CVD). Until new evidence is available, clinicians should not promise patients that folate supplementation will improve cognition or decrease cardiovascular risk.