When should a dosage of 4 mg of folic acid be indicated?

A dosage of 4 mg of folic acid is specifically indicated for women who have had a previous child with a neural tube defect (NTD). This increased dosage is recommended because it significantly reduces the risk of recurrence in subsequent pregnancies. Neural tube defects, such as spina bifida and anencephaly, are serious congenital anomalies that can occur during the early stages of fetal development due to insufficient folic acid levels.

For women with a history of NTDs, the standard recommendation is to initiate folic acid supplementation at least one month before conception and continue through the first trimester. This proactive approach is crucial because the neural tube forms in the first few weeks of pregnancy, often before a woman even realizes she is pregnant.

While preeclampsia, gestational diabetes, and multiple gestations have their specific management protocols and nutritional considerations, they do not warrant a standard recommendation for a higher dose of folic acid like a history of NTDs does. In the case of multiple gestations, while higher doses of folic acid might be beneficial due to the increased risk of NTDs, the established guideline for a prior child with an NTD precedes those considerations. Therefore, the key context lies in the severe implications of N