Higher doses of folic acid in early pregnancy improve verbal and behavioral skills in children

Higher doses of folic acid in early pregnancy improve verbal and behavioral skills in children

According to a preliminary study published today March 4, 2025, the preliminary study presented today March 4-9, 2025 at the American Academy of Neurology, taking place April 5-9, 2025 in San Diego and online.

Folic acid during pregnancy has been shown to reduce deformities and improve intellectual abilities in children, but the best dose of folic acid is unknown. Our study provides new information showing a positive association between folic acid intake during early pregnancy and brain health outcomes in children, with no negative effects at higher doses. “

Kimford J. Meador, MD, PhD, PhD,Study authorfrom Stanford University in Palo Alto, California, and a Fellow of the American Academy of Neurology

The study examined 345 children when they were six years old. Of the participants, 262 were children of women with epilepsy and 83 were children of women without epilepsy.

Researchers recorded doses of folic acid consumed by their mothers in the first 12 weeks of pregnancy and divided the children into five groups based on average dosage: no folic acid, folic acid up to 0.4 milligrams (mg) per day; more than 0.4 to 1.0 mg per day; more than 1.0 to 4.0 mg per day; and more than 4.0 mg per day. The current recommended dose during pregnancy for the general population is 0.4 mg per day, while women with epilepsy may be prescribed a higher dose.

Children were given several tests to assess verbal skills. For example, for a vocabulary test, participants were asked to describe objects, actions, or concepts presented in each picture with one word. For the general population, scores on these verbal tests range from 70 to 130, with a mean of 100, with higher scores indicating better ability.

Parents also completed questionnaires to assess children's behaviors such as communication skills, social skills, and daily living skills. The results of these tests were combined for an overall standardized behavior score. For the general population, scores range from 70 to 130 with a mean of 100, with higher scores indicating better ability.

After adjusting for factors such as mother's IQ, epilepsy medications and pregnancy complications, researchers found that the average verbal score for children of women who took folic acid was 108, compared to 96 children of women who did not take folic acid. The average behavior score for children of women who took folic acid was 102 compared to 82 children of women who did not take folic acid.

When researchers looked only at children whose mothers took folic acid during pregnancy, the scores found that levels were similar between low and high doses of folic acid. Children of mothers taking a low dose had a similar average verbal score of 110 compared to 108 for children of mothers taking a high dose. Children of people taking a low dose and children of people taking a high dose had average behavior scores of 103.

"While previous studies have found risks with higher doses, for people who are pregnant or planning to have children, these results suggest that taking a higher dose of folic acid early in pregnancy may still have a positive impact on the health of their child," Meador said. “Additional studies are needed to determine the best dose of folic acid to maximize benefits and minimize risks for neurodevelopmental and other outcomes, which may vary for different groups of women.”

A limitation of the study was that it did not examine other factors that may influence folic acid intake and absorption, such as other vitamins and genetics.

The study was supported by the National Institute of Neurological Disorders and Stroke and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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