Which is the recommended daily folic acid intake for someone who has had a prior fetal loss due to neural tube defect?

• A. 0.4 mg/day
• B. 4 mg/day
• C. 1 mg/day
• D. 2 mg/day

Answer: (B)

Having a prior neural tube defect in a previous pregnancy signals a high risk for recurrence, so a higher folic acid dose is used to maximize protection. Neural tube closure happens very early in pregnancy, often before a woman knows she’s pregnant, which is why starting supplementation before conception is essential.

For someone with this history, the recommended daily folic acid intake is 4 mg (4000 mcg). This higher dose is taken daily from at least one month before conception and continued through the first trimester to significantly reduce the risk of another neural tube defect. In contrast, the general population is advised to take about 0.4 mg daily, which is not sufficient for someone with prior NTD. Doses like 1 mg or 2 mg are not the standard for recurrence prevention, though clinicians may tailor decisions based on individual risk factors. After the critical early weeks, the dose is typically reduced to the standard 0.4 mg/day if no other risk factors persist.