| Summary: | Reductions in folate testing have been proposed on the basis of low levels of deficiency in fortified populations. The very low deficiency rate in Canada signals that reconsideration of the necessity of folate testing nationwide may be required, particularly in populations that could potentially benefit from targeted supplementation. Supplementation has not been linked to any adverse side-effects apart from potentially masking underlying vitamin B12 deficiency, and possible central nervous system and gastrointestinal side effects at 15 times the current tolerable upper limit of 1000 micrograms; however, the potential harms of foregoing testing for supplementation are unknown. The direct cost of folate testing is substantially higher than supplementation, although no formal cost-effectiveness analyses have been conducted. As well, the clinical utility of folate testing is unclear. This review will address lack of clarity surrounding the clinical utility and resource implications of folate testing, as well as the uncertainty regarding the appropriate analytical methods and clinical indications for routine folate testing
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