scholarly journals Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO

2015 ◽  
Vol 19 (1) ◽  
pp. 176-189 ◽  
Author(s):  
Sandra Gomes ◽  
Carla Lopes ◽  
Elisabete Pinto
Keyword(s):  
Folic Acid ◽  
First Trimester ◽  
Developed Countries ◽  
Folic Acid Supplementation ◽  
Healthy Diet ◽  
Folate Intake ◽  
Childbearing Age ◽  
Health Organizations ◽  
Acid Supplementation ◽  
Periconceptional Period

AbstractObjectiveTo summarize the recommendations on folate intake and folic acid supplementation and fortification in the periconceptional period, aimed at prevention of neural tube defects (NTD), provided by official health organizations in different countries worldwide and WHO.DesignInformation on recommendations for folate and folic acid intake in the periconceptional period was gathered from the websites of official national health organizations of several countries worldwide and from the WHO website.SettingWHO, selected developed countries and emerging economies, totalling thirty-six countries worldwide (some European, BRICS, G8, Asian Tiger/Asian Dragon and Australia).ResultsRecommendations differ between countries, although the majority (69·4 %) recommend a healthy diet plus a folic acid supplement of 400 µg/d from preconception (4–12 weeks) until the end of the first trimester of pregnancy (8–12 weeks). The same recommendation is issued by the WHO. Dosages for women at high risk of NTD are up to 4–5 mg/d (for 41·7 % of studied countries). The recommended intake for folate is in the range of 300–400 µg/d for women of childbearing age and 500–600 µg/d for pregnant women in different countries and WHO. Five countries emphasize the importance of a healthy diet rendering supplementation needless. By contrast, five others advise a healthy diet and supplementation plus mandatory fortification. Only one mentions the importance of ensuring an adequate folate status and refers to checking with a health-care provider on the need for supplements.ConclusionsDifferent recommendations regarding folate and folic acid, seeking NTD prevention, are available worldwide; however, most countries and WHO focus on a healthy diet and folic acid supplementation of 400 µg/d periconceptionally.

scholarly journals First‐Trimester Maternal Folic Acid Supplementation Reduced Risks of Severe and Most Congenital Heart Diseases in Offspring: A Large Case‐Control Study

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Yanji Qu ◽  
Shao Lin ◽  
Jian Zhuang ◽  
Michael S. Bloom ◽  
Maggie Smith ◽  
...  
Keyword(s):  
Folic Acid ◽  
Congenital Heart ◽  
Case Control Study ◽  
First Trimester ◽  
Folic Acid Supplementation ◽  
Case Control ◽  
Childbearing Age ◽  
Acid Supplementation ◽  
Multivitamin Use ◽  
Control Study

Background Maternal folic acid supplementation (FAS) reduces the risk of neural tube defects in offspring. However, its effect on congenital heart disease (CHDs), especially on the severe ones remains uncertain. This study aimed to assess the individual and joint effect of first‐trimester maternal FAS and multivitamin use on CHDs in offspring. Methods and Results This is a case‐control study including 8379 confirmed CHD cases and 6918 controls from 40 healthcare centers of 21 cities in Guangdong Province, China. Adjusted odds ratios (aORs) of FAS and multivitamin use between CHD cases (overall and specific CHD phenotypes) and controls were calculated by controlling for parental confounders. The multiplicative interaction effect of FAS and multivitamin use on CHDs was estimated. A significantly protective association was detected between first‐trimester maternal FAS and CHDs among offspring (aOR, 0.69; 95% CI, 0.62–0.76), but not for multivitamin use alone (aOR, 1.42; 95% CI, 0.73–2.78). There was no interaction between FAS and multivitamin use on CHDs ( P =0.292). Most CHD phenotypes benefited from FAS (aORs ranged from 0.03–0.85), especially the most severe categories (ie, multiple critical CHDs [aOR, 0.16; 95% CI, 0.12–0.22]) and phenotypes (ie, single ventricle [aOR, 0.03; 95% CI, 0.004–0.21]). Conclusions First‐trimester maternal FAS, but not multivitamin use, was substantially associated with lower risk of CHDs, and the association was strongest for the most severe CHD phenotypes. We recommend that women of childbearing age should supplement with folic acid as early as possible, ensuring coverage of the critical window for fetal heart development to prevent CHDs.

scholarly journals Magnitude and Associated Factors of Neural Tube Defects in Ethiopia: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 ◽  
pp. 2333794X2093942
Author(s):  
Zebenay Workneh Bitew ◽  
Teshager Worku ◽  
Anmut Alebel ◽  
Ayinalem Alemu
Keyword(s):  
Folic Acid ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Associated Factors ◽  
Unplanned Pregnancy ◽  
First Trimester ◽  
Folic Acid Supplementation ◽  
Childbearing Age ◽  
Acid Supplementation ◽  
Pooled Prevalence

Neural tube defects remain a major problem in developing countries, but there are limited comprehensive national reports to date in Ethiopia. Therefore, this study aimed to assess the prevalence of neural tube defects and associated factors in Ethiopia. Electronic databases and other sources were used to retrieve studies. Fifteen out of 862 studies were included in the final analysis. The estimated pooled prevalence of neural tube defects among children in Ethiopia was 63.3 cases per 10 000 children. The pooled prevalence of spinal bifida, anencephaly, and encephalocele was 41.09, 18.90, and 1.07 per 10 000 children, respectively. Previous family history and unplanned pregnancy were risk factors for neural tube defects. Folic acid supplementation during the first trimester of pregnancy was found to be protective. Neural tube defects are widespread in Ethiopia. Hence, fortification of food with folic acid or folic acid supplementation during childbearing age is recommended.

scholarly journals Incidence of neural tube defects and their risk factors within a cohort of Moroccan newborn infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khenata Forci ◽  
El Arbi Bouaiti ◽  
Mohamed Hassan Alami ◽  
Asmaa Mdaghri Alaoui ◽  
Amal Thimou Izgua
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Newborn Infants ◽  
First Trimester ◽  
Folic Acid Supplementation ◽  
Medical Monitoring ◽  
Acid Supplementation ◽  
Periconceptional Period

Abstract Background Neural tube defects (NTDs) are a group of birth defects that result from a partial or complete failure of the neural tube to close during embryogenesis. Their prevalence varies between 0.5 to 2 per 1000 births in countries without folic acid supplementation. The aim of our study is to assess the NTDs incidence and describe the risk factors within Moroccan newborn infants. Method This is a descriptive study over a period of 5 and a half years including all births at “Les Orangers” Maternity and Reproductive Health Hospital of Rabat with notification of NTD cases, whether isolated or combined with other anomalies. Data were reported on pre-established sheets and on the teratovigilance registry. Statistical analysis was performed with SPSS version 18 statistical software. Results During the study period, 43,923 births were recorded including 44 cases of neural tube defects, an incidence rate of 1 per 1000 births, with a female predominance; sex ratio = 0.8. These defects included anencephaly (50%), spina bifida (38.6%) and encephalocele (11.4%). The risk factors detected during this study include consanguinity (34%), consumption of fenugreek or other plants (36%), diabetes (4.5%) and medication (2.2%). A family history of malformation was reported in 6.8% of cases and among siblings in 4.5% of cases. The average maternal age was 30.38 ± 6.88 and the average gestational age was 36.80 ± 5.11. A quarter of mothers did not benefit from any medical monitoring during pregnancy while 59% did not take folic acid supplementation during the first trimester of pregnancy and none of them took B9 vitamin during the periconceptional period. The antenatal diagnosis was performed in 63% of cases. The mortality rate was 3.8 per 10,000 and 16% of cases evolved positively. Conclusion NTDs require high intensity and multidisciplinary care which stresses the importance, in our context, of strengthening and optimizing acid folic supplementation strategies during the periconceptional period.

Folic acid supplementation, dietary folate intake and risk of small for gestational age in China

2019 ◽  
Vol 23 (11) ◽  
pp. 1965-1973
Author(s):  
Huaqi Guo ◽  
Baohong Mao ◽  
Meng Wang ◽  
Qing Liu ◽  
Liping Yang ◽  
...  
Keyword(s):  
Folic Acid ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Folic Acid Supplementation ◽  
Folate Intake ◽  
Care Hospital ◽  
Dietary Folate ◽  
Acid Supplementation ◽  
Dietary Folate Intake ◽  
Reduced Risk

AbstractObjective:To investigate the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of small for gestational age (SGA) and to examine the joint effect of folic acid supplementation and dietary folate intake on the risk of SGA.Design:Participants were interviewed by trained study interviewers using a standardized and structured questionnaire. Information on birth outcomes and maternal complications was abstracted from medical records and dietary information was collected via a semi-quantitative FFQ before conception and during pregnancy.Setting:A birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital.Participants:Women (n 8758) and their children enrolled in the study.Results:Folic acid supplementation was associated with a reduced risk of SGA (OR = 0·72, 95 % CI 0·60, 0·86), with the reduced risk seen mainly for SGA at ≥37 weeks of gestational age (OR = 0·70, 95 % CI 0·58, 0·85) and nulliparous SGA (OR = 0·67, 95 % CI 0·54, 0·84). There was no significant association between dietary folate intake and SGA risk.Conclusions:Our study suggested that folic acid supplementation was associated with a reduced risk of SGA and the risk varied by preterm status and parity.

Maternal Folic Acid Intake and Risk of Nonsyndromic Orofacial Clefts: A Hospital-Based Case–Control Study in Bangalore, India

2019 ◽  
Vol 57 (6) ◽  
pp. 678-686
Author(s):  
Vivienne J. Mendonca
Keyword(s):  
Folic Acid ◽  
Case Control Study ◽  
Folic Acid Supplementation ◽  
Folic Acid Intake ◽  
Orofacial Clefts ◽  
Dietary Folate ◽  
Acid Supplementation ◽  
Folic Acid Supplements ◽  
Periconceptional Period ◽  
Control Study

Background: Orofacial clefts are the most common congenital anomaly worldwide. Cleft etiology appears to be multifactorial, with genetic and environmental components. Although periconceptional folic acid supplementation has been shown to be protective for neural tube defects, current evidence for its role in cleft prevention is mixed with few studies from low- and middle-income countries. Aim: To investigate the association between periconceptional folic acid intake and incidence of nonsyndromic orofacial clefts among infants in Bangalore, India. Methods: A hospital-based case–control study (106 cases, 212 controls) utilizing a questionnaire to collect data on prenatal supplements, dietary folate, and potentially confounding factors. Multivariate logistic regression analysis was used to assess relationships between folic acid supplementation and all nonsyndromic clefts, and in separate analyses for cleft lip and/or palate (CL/P) and cleft palate (CP), adjusting for statistically significant variables. Results: A statistically significant protective association was found for separate folic acid supplements (not combined with iron or multivitamins) taken in the periconceptional period and all clefts combined (adjusted odds ratio [OR]: 0.62, 95% confidence interval [CI], 0.45-0.86) and CL/P (adjusted OR: 0.57; 95% CI, 0.38-0.86). Higher levels of dietary folate were found to be associated with a reduced risk for all clefts (adjusted OR: 0.98, 95% CI, 0.96-0.99), CL/P (adjusted OR: 0.98, 95% CI, 0.96-0.99), and CP (adjusted OR: 0.96, 95% CI, 0.93-0.99). Conclusion: This study provides limited evidence for a protective association of periconceptional folic acid supplementation with nonsyndromic orofacial clefts. The low proportion of mothers taking folic acid supplements in the periconceptional period highlights the need for increased education and awareness regarding prenatal nutrition.

scholarly journals Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1108 ◽  
Author(s):  
Aurore Camier ◽  
Manik Kadawathagedara ◽  
Sandrine Lioret ◽  
Corinne Bois ◽  
Marie Cheminat ◽  
...  
Keyword(s):  
Folic Acid ◽  
Family Income ◽  
Social Inequalities ◽  
Multinomial Logistic Regression ◽  
Unplanned Pregnancy ◽  
Folic Acid Supplementation ◽  
Sociodemographic Characteristics ◽  
Acid Supplementation ◽  
Periconceptional Period ◽  
Maternal Overweight

Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l’Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.

scholarly journals Awareness, use and information sources of folic acid supplementation to prevent neural tube defects in pregnant Japanese women

2017 ◽  
Vol 21 (4) ◽  
pp. 732-739 ◽  
Author(s):  
Shumi Yamamoto ◽  
Yoshinao Wada
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Folic Acid Supplementation ◽  
Japanese Women ◽  
Reproductive Age ◽  
Current Status ◽  
Public Health Approach ◽  
Childbearing Age ◽  
Acid Supplementation ◽  
Folic Acid Supplements

AbstractObjectiveFolic acid supplementation and folate-rich diets are recommended for women of childbearing age worldwide to prevent congenital anomalies. We aimed to determine the current status of folic acid supplementation among pregnant Japanese women and identify means to increase the intake of these supplements.DesignCross-sectional study.SubjectsA total of 1862 pregnant women who consulted the perinatal centre from September 2014 to December 2015 completed a questionnaire concerning knowledge about folic acid, sources of information and the use of folic acid supplements.SettingOsaka Medical Center and Research Institute for Maternal and Child Health (Japan).ResultsIn our study population, only 20·5 % of pregnant women took folic acid supplements periconceptionally even though 70·4 % knew about the protective effect of folic acid. A multivariate analysis demonstrated that age ≥35 years (OR=2·80; 95 % CI 1·24, 6·29) and knowledge of the benefits of folic acid (OR=2·64; 95 % CI 1·92, 3·62) were associated with periconceptional folic acid use, and multiparity was negatively associated with such use. Compared with those who took folic acid supplements periconceptionally, women who did not take supplements received information through passive and less interactive media.ConclusionsAlthough folic acid awareness was relatively high among pregnant Japanese women, folic acid supplementation before conception was insufficient. To increase the intake of folic acid supplements in countries in which foods are not fortified with folic acid, an effective public health approach promoting behavioural change is necessary for women of reproductive age.

scholarly journals The effect of folate fortification on folic acid-based homocysteine-lowering intervention and stroke risk: a meta-analysis

2014 ◽  
Vol 18 (8) ◽  
pp. 1514-1521 ◽  
Author(s):  
Rui Zeng ◽  
Chun-Hua Xu ◽  
Yuan-Ning Xu ◽  
Ya-Li Wang ◽  
Mian Wang
Keyword(s):  
Folic Acid ◽  
Randomized Controlled Trials ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Folic Acid Supplementation ◽  
Folate Intake ◽  
Controlled Trials ◽  
Acid Supplementation ◽  
Randomized Controlled ◽  
Significant Difference

AbstractObjectiveFolate and vitamin B12 are two vital regulators in the metabolic process of homocysteine, which is a risk factor of atherothrombotic events. Low folate intake or low plasma folate concentration is associated with increased stroke risk. Previous randomized controlled trials presented discordant findings in the effect of folic acid supplementation-based homocysteine lowering on stroke risk. The aim of the present review was to perform a meta-analysis of relevant randomized controlled trials to check the how different folate fortification status might affect the effects of folic acid supplementation in lowering homocysteine and reducing stroke risk.DesignRelevant randomized controlled trials were identified through formal literature search. Homocysteine reduction was compared in subgroups stratified by folate fortification status. Relative risks with 95 % confidence intervals were used as a measure to assess the association between folic acid supplementation and stroke risk.SettingThe meta-analysis included fourteen randomized controlled trials,SubjectsA total of 39 420 patients.ResultsHomocysteine reductions were 26·99 (sd 1·91) %, 18·38 (sd 3·82) % and 21·30 (sd 1·98) %, respectively, in the subgroups without folate fortification, with folate fortification and with partial folate fortification. Significant difference was observed between the subgroups with folate fortification and without folate fortification (P=0·05). The relative risk of stroke was 0·88 (95 % CI 0·77, 1·00, P=0·05) in the subgroup without folate fortification, 0·94 (95 % CI 0·58, 1·54, P=0·82) in the subgroup with folate fortification and 0·91 (95 % CI 0·82, 1·01, P=0·09) in the subgroup with partial folate fortification.ConclusionsFolic acid supplementation might have a modest benefit on stroke prevention in regions without folate fortification.

scholarly journals Consumer preferences for micronutrient strategies in China. A comparison between folic acid supplementation and folate biofortification

2013 ◽  
Vol 17 (6) ◽  
pp. 1410-1420 ◽  
Author(s):  
Hans De Steur ◽  
Shuyi Feng ◽  
Shi Xiaoping ◽  
Xavier Gellynck
Keyword(s):  
Folic Acid ◽  
Consumer Preferences ◽  
Folate Deficiency ◽  
Folic Acid Supplementation ◽  
Shanxi Province ◽  
Product Choice ◽  
Childbearing Age ◽  
Acid Supplementation ◽  
Ex Post ◽  
Limited Effectiveness

AbstractObjectiveDespite public health efforts, folate deficiency is still largely prevalent in poor, rural populations and continues to cause a large burden of disease. The present paper determines and compares consumer preferences for two folate strategies: folic acid supplementationv.folate biofortification, i.e. the enhancement of the folate content in staple crops.DesignExperimental auctions with non-repeated information rounds are applied to rice in order to obtain willingness-to-pay for folate products. Thereby, GM or non-GM folate-biofortified rice (FBR) is auctioned together with rice that is supplemented with free folic acid pills (FAR).SettingShanxi Province (China) as a high-risk region of folate deficiency.SubjectsOne hundred and twenty-six women of childbearing age, divided into a school (n60) and market sample (n66).ResultsDespite differences according to the targeted sample, a general preference for folate biofortification is observed, regardless of the applied breeding technology. Premiums vary between 33·9 % (GM FBR), 36·5 % (non-GM FBR) and 19·0 % (FAR). Zero bidding behaviour as well as the product choice question, respectively, support and validate these findings. The targeted sample, the timing of the auction, the intention to consume GM food and the responsibility for rice purchases are considered key determinants of product choice. A novel ex-post negative valuation procedure shows low consistency in zero bidding.ConclusionsWhile the low attractiveness of FAR provides an additional argument for the limited effectiveness of past folic acid supplementation programmes, the positive reactions towards GM FBR further support its potential as a possible complementary micronutrient intervention.

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