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[Folic acid in the prevention of neural tube defects]
A Novakov-Mikić1, T Vejnović, L Ivanović
1Klinicki centar, Medicinski fakultet, Novi Sad.
Insights
Neural tube defects (NTD) can be reduced with folic acid supplementation. Women planning pregnancy should take 0.4 mg daily, while those with a history of NTD should take 4 mg daily to prevent recurrence.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Nutritional Science
Context:
- Neural tube defects (NTD) are congenital anomalies affecting the brain and spine, with a prevalence of 11.2 per 10,000 live births in continental Europe.
- Maternal folate levels significantly impact the risk of NTD, with inadequate intake linked to preterm delivery and growth retardation.
Purpose:
- To review the role of folic acid in preventing neural tube defects.
- To outline recommended folic acid supplementation strategies for primary and secondary prevention of NTD.
Summary:
- Folic acid supplementation before conception and during early pregnancy is crucial for preventing NTD.
- Recommended doses vary: 0.4 mg daily for primary prevention and 4 mg daily for secondary prevention in women with a history of NTD or affected offspring.
- Educational campaigns are essential to promote awareness and adherence to folic acid supplementation.
Impact:
- Implementing recommended folic acid supplementation can significantly reduce NTD incidence.
- Public health initiatives promoting preconception folic acid intake can improve birth outcomes.
- Further research may explore optimal food fortification strategies and individual risk assessment for NTD prevention.
Introduction:
The term neural tube defects (NTD) stands for anencephaly, iniencephaly, cephalocoele and spina-bifida. The cause of these anomalies is failure of brain spinal cord to properly develop, together with their protective shield of skull and spine, around the 4th gestational week. The prevalence of NTD in continental Europe is 11.2 10,000 live births.
The Level Of Folates In Serum And Ntd:
The level of folates in serum can influence the risk of a child affected with NTD. Studies on women with previous pregnancies with NTD showed that supplementary intake of folic acid, with or without other vitamins, preconceptual period throughout the first trimester has a preventive effect on its recurrence. Inadequate intake of folic acid is also connected with preterm delivery, intrauterine growth retardation and placental abruption and infarction.
Folates In Nutrition:
It is not folic acid, but folates, from the vitamin B group, that can naturally be found in food. There are several groups of folates that differ in the quantity by which they can be absorbed from food. Folates are temperature and storage sensitive and cooking can cause a significant fall of their concentration in food.
Folic Acid Supplementation:
The mean daily intake of folates by food is 0.218 mg whereas a reference nutritive intake for a woman of reproductive age is 0.2 mg per day. The currently recommended daily dose for prevention of first NTD occurrence is 0.4 mg, so it is clear that a certain amount of folic acid has to be supplemented preconceptionally and during the first trimester. It can be done in two ways, by telling all women to take it before conceiving, or to fortify food with sufficiently high doses of folic acid in order to achieve adequate serum levels. Neither of the ways is ideal, for not all women would take the supplement, and by aggressively fortifying the food, we create a potential hazard to those that do not need it and may have some problems with the excess of it. The best solution would be a widespread campaign about the need for folic acid and the risks of NTD.
Conclusion:
Recommendations of The Expert Advisory Group on Folic Acid in prevention of neural tube defects has several aspects (1) reducing the risk of the first NTD occurrence by preconceptional vitamin supplementation of folic acid in the dose of 0.4 mg day, which would go on until the end of the 12th week (2) reducing the risk of NTD recurrence in offspring of men and women with spina-bifida or with obstetric history affected with NTD by preconceptional vitamin supplementation of folic acid in the dose of 4 mg daily during the first 12 weeks and (3) organizing educational programmes for medical staff as well as the whole population in order to popularize vitamin supplementation.