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Occurrence Prevention:
In 1992 the U. S. Public Health Service (USPHS) published the
recommendation that all women of childbearing age consume 0.4 mg
(400 micrograms) of folic acid daily to prevent two common and
serious birth defects, spina bifida and anencephaly.
CDC estimates that 50-70% of these birth defects could be
prevented if this recommendation were followed before and
during early pregnancy.
All women between 15 and 45 years of age should consume 0.4 mg of
folic acid per day because half of U.S. pregnancies are
unplanned and because these birth defects occur very early in
pregnancy (3-4 weeks after conception), before most women know
they are pregnant.
Recurrence Prevention:
All women who have already had an NTD-affected pregnancy should
consume 0.4 mg (400 mcg) of folic acid every day when not planning to
become pregnant. Half of all pregnancies in the U. S. are unplanned.
When these women are planning to become pregnant, they should consult
with their health care provider about the desirability of following the
August 1991 USPHS guideline. The guideline called for consumption of 4
milligrams (4000 micrograms) of folic acid daily beginning one month
before they start trying to get pregnant and continuing through the
first three months of pregnancy. Although it appears that a lower dose,
such as 0.4 milligrams, may have as great a beneficial effect as 4.0
milligrams, many health care providers recommend the higher dose. This
recommendation is based on data from the most rigorous scientific study
involving women who had previous pregnancies affected by NTDs. This
dosage should be prescribed and monitored by the health care provider.
Typically, a health care provider will prescribe one prenatal vitamin
plus three 1 mg tablets of folic acid a day to get this dosage. Keep in
mind that we do not understand all the causes of neural tube defects.
We do know that 50%-70% can be prevented by consuming sufficient amounts
of folic acid.
IOM Recommendation
In 1998, the Food and Nutrition Board of the National
Academy of Sciences Institute of Medicine (IOM) recommended that to
reduce their risk for an NTD-affected pregnancy, women capable of
becoming pregnant should take 400 micrograms of synthetic folic
acid daily, from fortified foods or supplements or a combination of the
two, in addition to consuming food folate from a varied diet.
Link to report.
Become Involved
Health care providers are important motivators of health
behavior change according to our research. You have the potential to
influence women of childbearing age to consume folic acid daily to
reduce their risk for NTD-affected pregnancies. Not only can you
encourage daily folic acid consumption in your face-to-face encounters,
but you can influence the community at large. The following are a few
ideas for spreading the word about the importance of childbearing age
women consuming folic acid daily:
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Ask editors of medical newsletters, journals, or
bulletins to print articles about the importance of folic acid.
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Gather a group of health care professionals in the
community to be featured on local television and radio shows.
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Convince other health care providers to present the
folic acid message to medical staff while on grand rounds.
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Use educational "prescription pads," and give a
prescription for folic acid to every woman of childbearing age as a
reminder. Encourage your colleagues to do the same.
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Display posters, brochures, flyers, and articles about
folic acid in your office and building. (Order
free from CDC.)
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Provide a message about folic acid on your phone "hold
line."
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Wear a folic acid button that reinforces the message.
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Encourage your staff to ask about multivitamins and/or
folic acid intake when they take a history.
Date: July 26, 2005
Content source: National Center on Birth Defects and Developmental
Disabilities
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