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Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects
1Centre for the Study of Mothers' and Children's Health, La Trobe University, 251 Faraday St, Carlton, Vic, Australia, 3053. j.lumley@latrobe.edu.au
Insights
Periconceptional folate supplementation significantly reduces neural tube defects. Increased awareness and availability of folate information are crucial for preventing these birth defects.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Genetics
Background:
- Neural tube defects (NTDs) are congenital abnormalities affecting the developing brain and spinal cord.
- Periconceptional period, encompassing preconception and early pregnancy, is critical for NTD prevention.
Purpose of the Study:
- To evaluate the impact of periconceptional folate or multivitamin intake on NTD prevalence.
- To assess the efficacy of different supplementation strategies and information dissemination.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched Cochrane Pregnancy and Childbirth Group trials register (up to April 2001).
- Included trials compared folate/multivitamins with placebo, varying dosages, or dietary interventions.
Main Results:
- Periconceptional folate supplementation demonstrated a significant reduction in NTD incidence (RR 0.28).
- Folate supplementation did not increase miscarriage or stillbirth but showed a possible rise in multiple gestation.
- Multivitamins alone or with folate did not offer additional preventive benefits for NTDs.
Conclusions:
- Periconceptional folate supplementation is highly effective in preventing neural tube defects.
- Enhancing public and health system awareness of folate's role is recommended.
- Further research is needed on food fortification with folate due to unresolved benefits and risks.
Background:
Neural tube defects arise during the development of the brain and spinal cord.
Objectives:
The objective of this review was to assess the effects of increased consumption of folate or multivitamins on the prevalence of neural tube defects periconceptionally (that is before pregnancy and in the first two months of pregnancy).
Search Strategy:
We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: April 2001.
Selection Criteria:
Randomised and quasi-randomised trials comparing periconceptional supplementation by multivitamins with placebo, folate with placebo, or multivitamins with folate; different dosages of multivitamins or folate; prepregnancy dietary advice and counselling in primary care settings to increase the consumption of folate-rich foods, or folate-fortified foods, with standard care; increased intensity of information provision with standard public health dissemination.
Data Collection And Analysis:
Two reviewers assessed trial quality and extracted data.
Main Results:
Four trials of supplementation involving 6425 women were included. The trials all addressed the question of supplementation and they were of variable quality. Periconceptional folate supplementation reduced the incidence of neural tube defects (relative risk 0.28, 95% confidence interval 0.13 to 0.58). Folate supplementation did not significantly increase miscarriage, ectopic pregnancy or stillbirth, although there was a possible increase in multiple gestation. Multivitamins alone were not associated with prevention of neural tube defects and did not produce additional preventive effects when given with folate. One dissemination trial, a community randomised trial, was identified involving six communities, matched in pairs, and where 1206 women of child-bearing age were interviewed following the dissemination intervention. This showed that the provision of printed material increased the awareness of the folate/neural tube defects association by 4%, (odds ratio 1.37, 95% confidence interval 1.33 to 1.42).
Reviewer'S Conclusions:
Periconceptional folate supplementation has a strong protective effect against neural tube defects. Information about folate should be made more widely available throughout the health and education systems. Women whose fetuses or babies have neural tube defects should be advised of the risk of recurrence in a subsequent pregnancy and offered continuing folate supplementation. The benefits and risks of fortifying basic food stuffs, such as flour, with added folate remain unresolved.