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Summary Thromboembolic disease remains the leading cause of maternal death in the UK. Recent literature has proposed that folate status is a strong predictor for venous thrombosis. Using thrombelastography (TEG®), we tested the hypothesis that folic acid supplementation is associated with a reduction in whole blood coagulability. Blood samples and questionnaire data were obtained at a mean gestation of 13·6 weeks (SD: 3·8, range: 6–38 weeks) from unselected consecutive women attending for their antenatal booking scan. Of 588 patients, 439 (74·7%) took folic acid. All TEG® parameters were less hypercoagulable in women that had taken folic acid compared with those that had not: mean maximum amplitude (MA) 60·3 versus 62·1; mean difference 1·8; 95% confidence interval 0·8, 2·8; P = 0·0001; mean coagulation index (CI) 0·54 versus 0·85; mean difference 0·31; 95% confidence interval 0·11, 0·5; P = 0·002. There was no difference in the incidence of the homozygous MTHFR mutation in patients taking folic acid (5·53%) compared with those that were not (4·08%). This study suggests that benefit may be derived from longer‐term treatment, although large multicentre studies are required to determine whether the relative hypocoagulability is associated with a reduction in risk of venous thrombosis.

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