Getting the message across to your patients about folic acid is simple and in most cases will take only a few minutes.

First, assess the patient’s risk:

• Determine her awareness regarding folic acid.
  • Ask what she knows about folic acid and its benefits
  • Ask if she is currently taking a vitamin supplement
• Discuss her family health history to determine if family members have a history of NTDs or have children with birth defects.
• Inquire about her ethnicity, because women of Hispanic background are at an increased risk for folic acid deficiency [90].
• Review her medical history to identify if any of her children were born with birth defects, or if any pregnancies resulted in a miscarriage.
• Ask her if she is planning to become pregnant.
• Assess what barriers may be preventing her from taking folic acid.

Next, counsel the patient:

• Explain the importance of a folic acid supplement in addition to a healthy diet. 

-If the patient is planning on becoming pregnant:

• Stress the fact that birth defects can occur before she realizes that she is pregnant and the importance of periconceptional folic acid intake.
• Recommend an appropriate level of folic acid intake based on your assessment.

-If the patient is not planning on becoming pregnant:

• Discuss some of the other benefits of taking a multivitamin containing folic acid.
• Recommend an appropriate level of folic acid intake based on your assessment, even if she is not planning to become pregnant.
• Suggest that the two of you discuss any future plans for pregnancy prior to conception, so that her health and that of her future child may be protected.

You may find it helpful to use a preconception care chart insert (PDF) to remind you to discuss folic acid with each patient.[113]

Repeating the message during numerous visits may eventually provide the incentive for a positive response on your patient’s part. If she understands the importance of your message, she will be more likely to comply with your recommendations.