RETIRED: Pre-conceptional Vitamin/Folic Acid Supplementation 2007: The Use of Folic Acid in Combination With a Multivitamin Supplement for the Prevention of Neural Tube Defects and Other Congenital Anomalies

Policy statement on folic acid and neural tube defects

“…The American College of Obstetricians and Gynecologists issued its practice guideline in 2003 and had very similar recommendations, including 0.4 mg for all women and 4 mg for women at higher risk. 49 The joint Society of Obstetricians and Gynaecologists of Canada and Motherisk guideline 50 had 10 components to their practice guideline. These were to recommend (1) education for all women of reproductive age about folate, (2) women maintain a healthy diet, (3) consumption of only one dose of a multivitamin, (4) that folic acid and multivitamins be widely available, (5) that 5 mg be given to not only prevent recurrence of NTDs but also cleft lip/palate, heart defects, limb defects, urinary tract abnormalities, and hydrocephalus, (6) that 5 mg of folic acid will not mask vitamin B12 deficiency, (7) primary prevention could be accomplished in one of three ways, with 0.4 -1 mg/day from vitamins and food, or 5 mg/day for high-risk groups (including certain ethnic groups) or those who have a poor lifestyle or evidence of poor compliance with medication use, (8) increased food fortification to 300 g/100 g flour, (9) the Canadian government consider increasing fortification with other vitamins, and (10) the organization of a consensus conference on the use of folic acid and multivitamins for the prevention of congenital anomalies.…”

Folic acid uptake by the human syncytiotrophoblast is affected by gestational diabetes, hyperleptinemia, and TNF-α

“…3 H-FA uptake in both NTB and DTB cells was found to be markedly acidic-pH stimulated. Strikingly, pH-dependence was greater in DTB cells, particularly for acidic pH values (5.0-6.0).…”

“…Finally, a 4-h exposure of BeWo cells to 1 or 10 μg/ml LPS concentrations known to induce proinflammatory cytokine (interleukin-6 and TNF-α) secretion in trophoblast cells (18) and to 300 ng/l TNF-α itself significantly reduced 3 We next tested the effect of selected GDM conditions on the kinetic parameters of 3 H-FA uptake in BeWo cells. A 4-h and a 24-h treatment with 1 and 100 ng/ml leptin, respectively, and a 4-h treatment with 10 μg/ml LPS did not alter the K m and V max of 3 H-FA uptake by this cell line (data not shown).…”

“…3 H-FA was used in concentrations of 20 or 50 nmol/l (except in the experiments for determination of the kinetics of 3 H-FA uptake).…”

“…Maternal-to-fetal transport of folates at the level of the syncytiotrophoblast epithelium is crucial for placental and fetal development and growth because neither the placenta nor the fetus can synthesize this vitamin. In fact, maternal folate deficiency has been associated with low birth weight and neural tube defects (2), and supplementation with FA during the periconceptional period reduces the incidence of such outcomes (2,3).…”