Folic Acid

• Pre-conception (all)
• High-dose for high-risk groups (DM, AEDs, BMI ≥30, prior NTD, haemoglobinopathy)

Cofactor for purine/thymidine synthesis & methylation — critical for closing neural tube (days 22–28 post-conception).

• 400 mcg OD — standard
• 5 mg OD — diabetes, AEDs, BMI ≥30, prior NTD, haemoglobinopathy
• Continue to 12 weeks; 5 mg may continue throughout

Standard

400 mcg OD pre-conception → 12 weeks

High-risk

5 mg OD pre-conception → 12 weeks (or throughout in haemoglobinopathy)

• CautionUntreated B12 deficiency — mask megaloblastic anaemia

• Generally none
• Rarely GI upset, rash

• • ~70% reduction in NTD risk.
• • May reduce risk of cleft lip/palate, congenital heart disease.

• Methotrexate

  Avoid

  Avoid pregnancy — folate antagonist

• Phenytoin, carbamazepine, valproate

  Caution

  ↓ folate levels — use 5 mg

• 💡 Counsel ALL women planning pregnancy.
• 💡 Fortify diet with leafy greens, legumes, fortified cereals.