Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies

Abstract

The quality of evidence in the document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). Summary Statement In Canada multivitamin tablets with folic acid are usually available in 3 formats: regular over-the-counter multivitamins with 0.4 to 0.6 mg folic acid, prenatal over-the-counter multivitamins with 1.0 mg folic acid, and prescription multivitamins with 5.0 mg folic acid. (III) Recommendations 1. Women should be advised to maintain a healthy folate-rich diet; however, folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect. (III-A) 2. All women in the reproductive age group (12-45 years of age) who have preserved fertility (a pregnancy is possible) should be advised about the benefits of folic acid in a multivitamin supplementation during medical wellness visits (birth control renewal, Pap testing, yearly gynaecological examination) whether or not a pregnancy is contemplated. Because so many pregnancies are unplanned, this applies to all women who may become pregnant. (III-A) 3. Folic acid supplementation is unlikely to mask vitamin B12 deficiency (pernicious anemia). Investigations (examination or laboratory) are not required prior to initiating folic acid supplementation for women with a risk for primary or recurrent neural tube or other folic acid-sensitive congenital anomalies who are considering a pregnancy. It is recommended that folic acid be taken in a multivitamin including 2.6 ug/day of vitamin B12 to mitigate even theoretical concerns. (II-2A) 4. Women at HIGH RISK, for whom a folic acid dose greater than 1 mg is indicated, taking a multivitamin tablet containing folic acid, should be advised to follow the product label and not to take more than 1 daily dose of the multivitamin supplement. Additional tablets containing only folic acid should be taken to achieve the desired dose. (II-2A) 5. Women with a LOW RISK for a neural tube defect or other folic acid-sensitive congenital anomaly and a male partner with low risk require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues. (II-2A) 6. Women with a MODERATE RISK for a neural tube defect or other folic acid-sensitive congenital anomaly or a male partner with moderate risk require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception. Women should continue this regime until 12 weeks' gestational age. (1-A) From 12 weeks' gestational age, continuing through the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (II-2A) 7. Women with an increased or HIGH RISK for a neural tu...

Folate, vitamin B12, ferritin and haemoglobin levels among women of childbearing age from a rural district in South India

“…All women planning pregnancy and, pregnant and breastfeeding mothers in India, especially from tribal and rural populations, should have access to nutrients rich food and supplementation [2,5,48]. Several reviews and guidelines have prescribed dosage for folic acid supplementation but there are no dosages identified for vitamin B12 supplementation [5].…”

“…All women planning pregnancy and, pregnant and breastfeeding mothers in India, especially from tribal and rural populations, should have access to nutrients rich food and supplementation [2,5,48]. Several reviews and guidelines have prescribed dosage for folic acid supplementation but there are no dosages identified for vitamin B12 supplementation [5]. Even at the prescribed dosages, monitoring of the consequences of folic acid and vitamin B12 intake are required to measure harmful effects of these at high concentrations [5,49].…”

“…Low folate and vitamin B12 levels in women are associated with megaloblastic anaemia [2] and, gestational hypertension and eclampsia [3] in the mother. Deficiency among mothers may increase the risk of many chronic and developmental disorders including neural tube disorders (NTDs) among their children [2,4,5]. Low folate level is an important determinant of spontaneous abortion, recurrent pregnancy loss, stillbirth [6][7][8], low birth weight [9][10][11] and preterm birth [10,12,13].…”

Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study

“…22 We interpret the importance of preconceptual folic acid as a possible proxy for planning a pregnancy, because women are recommended to start taking folic acid before they become pregnant. 23 Within the subset of women who did not breastfeed in the first birth, having an infant length of stay of 72 hours or more in both the first and second births increased the odds of breastfeeding in the second birth. We hypothesize that this may be related to the potential supports that may be offered to the mother during this time.…”

Managing epilepsy in women of childbearing age — Polish Society of Epileptology and Polish Gynecological Society Guidelines

“…The recommended dose in women taking antiepileptic drugs is 400 μg plus another 400 μg, preferably in the form of active folate [20]. High doses of folate, 5 mg daily, are recommended only if the woman or her partner and their offspring suffer from neural tube defects.…”