Thepotentialimpactsoffolicacidonmaternalandchild health beyond its effect on NTDs, combined with the lack of solid scientific evidence on the association between folic acidsupplementationandadverseoutcomesinmothersand offspring,havecreatedadilemmainfolicacidsupplementation during pregnancy. The proposed 4.0mg folic acid supplementationintheFACTstudyhasbeenrecommendedfor womenwithapreviouspregnancycomplicatedbyanNTDby thefederalgovernmentofCanada[37].Therecommendation bySOGC[38]isevenmoreliberalintermsofdosage(5.0mg insteadof4.0mg)andofthetargetedpopulation(including women with epilepsy or family history or high risk ethnic group or women without obvious increased risk but with poorsupplementationcompliance)forhighdosesupplementation. The SOGC has recently changed their recommendation, partly because of the lack of evidence; however, many centersandphysiciansmaintaintheirpositiononliberaluse ofhighdosefolicacidsupplementationforsuchindications as diabetes and obesity throughout pregnancy (Dr. Mark Walker,SIOGCChair,personalcommunication).Ifhighdose folic acid is truly beneficial and more conclusive evidence ofthebenefitisnotforthcoming,thistreatmentmaynotbe offeredtowomenatincreasedriskofNTDsandotheradverse outcomes such as PE, thus denying future generations of womenandtheiroffspringthispotentiallybeneficialtherapy. On the other hand, if high dose folic acid supplementation isnottrulybeneficialandmoreevidenceconcerninglackof benefitisnotforthcoming,practicemaygraduallychangeto increase the dose of folic acid supplementation, particularly because there are presently no other effective therapies to offer.