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Folic Acid and Pregnancy

NICE guideline [NG247] Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years. Published: Jan 2025. NICE CKS Pre-conception - advice and management: Scenarior: Pre-conception advice for all women. Last revised: Jun 2025.

Guidelines

NICE recommends taking the Healthy Start vitamins (free supplements provided by the NHS to eligible pregnant women) that contain:
  • Folic acid 400 micrograms
  • Vitamin C 70mg
  • Vitamin D 400 IU
 

Vitamin A supplementation is not recommended during pregnancy.

Pregnant women should avoid taking supplements containing vitamin A (retinol) and should not eat liver or liver products, as these contain high levels of vitamin A. Excess vitamin A during pregnancy has potential teratogenic effects.

  • ALL women who are planning pregnancy → take before attempting
  • ALL women who are already pregnant → take ASAP
 

It is best practice to start folic acid BEFORE conception.

This is because the neural tube closes within the first 4 weeks of gestation, starting folic acid only after a +ve pregnancy test may miss this crucial window for neural tube defect prevention.

Folic acid should be taken from whenever started (ideally pre-conception) until 12 weeks of pregnancy

Standard dose: folic acid 400 micrograms (not mg!) daily

High-dose folic acid 5mg daily should be offered to those at increased risk of having a baby with neural tube defect or other congenital malformation:
  • Partner with neural tube defect
  • Personal family history of neural tube defect
  • Previous pregnancy with a neural tube defect
  • Diabetes (1 and 2)
  • Sickle cell anaemia and thalassaemia
  • Taking anti-epileptic and HIV medicines
 

Overweight / obesity used to be an indication for high-dose folic acid. However, this alone is no longer an indication.
 

Reassure anyone with a body mass index (BMI) of 25 kg/m2 or more who is planning to become pregnant or is in the first 12 weeks of pregnancy that they do not need to take more than 400 micrograms of folic acid a day, unless they have any of the factors listed in recommendation 1.1.5. [2025]

References

Author: Adams Lau
Reviewer:
Last edited: 10/07/25