Folate Deficiency Treatment & Management

Updated: Jul 20, 2022
  • Author: Katherine Coffey-Vega, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Treatment

Approach Considerations

The dosage of folic acid needed to prevent or reverse folic acid deficiency varies with the clinical circumstances, as follows [49] :

  • Folate-deficient megaloblastic anemia due to dietary insufficiency or antiepileptic drugs: 5 mg/day for 4 months
  • Malabsorption: Up to 15 mg/day for 4 months
  • Chronic hemolytic states and kidney dialysis: for prophylaxis, 5 mg daily to weekly, depending on the patient's diet and rate of hemolysis

Referral to a dietician may be indicated to ensure that the patient has appropriate dietary intake of folic acid. Fruits, vegetables, and fortified foods constitute the primary dietary source of folic acid. [2]  

Recommended intakes as published by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies [21]  are as follows (RDA=recommended daily allowance, DFE=dietary folate equivalents, UL=tolerable upper level):

  • Adults and teenagers aged 14-19 years (male or female): RDA, 400 mcg DFE; UL, 1000 mcg DFE
  • Pregnant females: RDA, 600 mcg DFE; UL, 1000 mcg DFE
  • Lactating females: RDA, 500 mcg DFE; UL, 1000 mcg DFE

Because of variable absorption rates, an approximation of total folate intake in a day can be calculated as follows:

Grams of DFEs provided = grams of food folate + 1.7 × (grams of folic acid supplementation)

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Prevention

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 Control and Prevention (CDC) recommends that women who have had a pregnancy affected by a neural tube defect consume 4000 μg of folic acid each day 1 month before becoming pregnant and through the first 3 months of pregnancy.  [2]   

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