Review Article
Volume 9 Issue 4 - 2020
Prospective Guidelines for Folic Acid Supplementation in Periconception Care for the Prevention of Neural Tube Defects
Emmanuella Solomon1,2 and Nicholas A Kerna3*
1University of Health and Humanities, Tortola, BVI
2University of Science, Arts and Technology, Montserrat, BWI
3SMC–Medical Research, Thailand
*Corresponding Author: Nicholas A Kerna, POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Received: March 09, 2020; Published: March 23, 2020




Abstract

Neural tube defects (NTDs) are unwanted congenital expressions associated with a folic acid deficiency in pregnant mothers. In the United States, 1–2 per 1000 children are born each year with disruptive anomalies due to neural tube defects. Augmenting the diet with folic acid (vitamin B9) supplementation by the maternal parent before conception and during the first trimester of pregnancy reduces the risk of NTDs in children. Folic acid and folate cannot be synthesized in sufficient amounts by the body and must be obtained from the diet or supplementation. Many women have sub-optimal levels of folic acid, which is essential for nucleic acid synthesis. Folic acid supplementation in pregnancy dates to the 1930s and 1940s. Currently, folic acid is recommended and prescribed for pregnant women and during preconception. However, an excess amount of folic acid can have adverse effects on the mother and fetus. Thus, an optimal folic acid prescribed dosage should be further investigated. Some studies have demonstrated that the current standard of folic acid supplementation could be more than what an individual woman’s body needs and can utilize, and excessive folic acid supplementation could prove harmful. A woman’s existing folic acid levels are rarely evaluated before recommending the standard, “one-size-fits-all” recommendation. Thus, it would be more effective (and potentially less harmful) to determine a woman’s folic acid level, and to prescribe an optimal dose customized for the individual. The following review provides 1) a historical backdrop to neural tube defects and folic acid, 2) describes the current folic acid supplementation protocol, and 3) suggests a more effective and potentially less harmful folic acid screening and supplementation regime. Continuing research and refining folic acid supplementation in periconception is worthwhile and fundamental as there are high financial and emotional costs associated with folic acid-related NTDs.

Keywords: Anaemia; Birth Defects; Folate; Folic Acid; Neural Tube Defects; Periconception; Pregnancy

References

  1. Firth HV., et al. “Oxford desk reference: clinical genetics”. Archives of Diseases in Childhood 91.8 (2006): 717-718. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083036/ 
  2. Bixenstine PJ., et al. “Folic acid supplementation before pregnancy: Reasons for non-use and association with preconception counseling”. Maternal Child Health Journal 19.9 (2015): 1974-1984. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589164/
  3. De-Regil L., et al. “Effects and safety of periconceptional folate supplementation for preventing birth defects”. Cochrane Database System Review 10 (2010): CD007950. https://www.ncbi.nlm.nih.gov/pubmed/20927767
  4. Hibbard BM. “The role of folic acid in pregnancy with particular reference to anemia, abruption and abortion”. Journal of Obstetrics and Gynaecology British Communication 71 (1964): 529-542. https://www.ncbi.nlm.nih.gov/pubmed/14194440
  5. Vaughan JM. “The Anaemias”. Oxford University Press London (1934). 
  6. Chanarin I. “The Megaloblastic Anemias”. 3rd edition. Blackwell Scientific, Oxford (1990). 
  7. Wills L and Mehta MM. “Studies in pernicious anemia of pregnancy. Preliminary report”. Indian Journal of Medical Research 17 (1930): 777-792.
  8. Wills L. “Treatment of pernicious anaemia of pregnancy and tropical anaemia with special reference to yeast extract as curative agent”. British Medical Journal 1 (1931): 1059-1064.
  9. Wills L and Evans BDF. “Tropical macrocytic anaemia: its relation to pernicious anaemia”. Lancet ii (1938): 416-421.
  10. Stokstad ELR and Manning PDV. “Evidence of a new growth factor required by chicks”. Journal of Biological Chemistry 125 (1938): 1550-1554. https://www.jbc.org/content/125/2/687.full.pdf
  11. Herbert V and Zalusky R. “Interrelation of vitamin B12 and folic acid metabolism: folic acid clearance studies”. Journal of Clinical Investigation 41.6 (1962): 1263-1276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC291041/
  12. Rickes EL., et al. “Crystalline vitamin B12”. Science 107.2781 (1948): 396-397. https://www.ncbi.nlm.nih.gov/pubmed/17783930
  13. Metz J. “Hematological implications of folate food fortification”. The South African Medical Journal 103.2 (2013): 978-981. https://www.ncbi.nlm.nih.gov/pubmed/24300642 
  14. Smithells RW., et al. “Vitamin deficiencies and neural tube defects”. Archives of Diseases of Childhood 51.12 (1976): 944-950. https://www.ncbi.nlm.nih.gov/pubmed/1015847
  15. Hibbard ED and Smithells RW. “Folic acid metabolism and human embryopathy”. Lancet 285.7398 (1965): 1254. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(65)91895-7/fulltext
  16. Laurence KM., et al. “Double-blinded randomized controlled trial of folate treatment before conception or recurrence of neural tube defects”. British Medical Journal 282.6275 (1981): 1509-1511. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505459/
  17. Czeizel AF and Dudas J. “Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation”. New England Journal of Medicine 327.26 (1992): 1832-1835. https://www.ncbi.nlm.nih.gov/pubmed/1307234
  18. Scott JM and Weir DG. “Role of folic acid/folate in pregnancy: prevention is better than cure”. In: Recent Advances in Obstetrics and Gynaecology (ed by J. Bonnard). Churchill Livingstone. Edinburgh 1 (1998): 1-20.
  19. Kirke PN., et al. “Maternal plasma folate and vitamin B12 are independent risk factors for neural tube defects”. Quarterly Journal of Medicine 86.11 (1993): 703-708. https://www.ncbi.nlm.nih.gov/pubmed/8265769
  20. Daly LE., et al. “Folate levels and neural tube defects. Implications for prevention”. Journal of the American Medical Association 274.21 (1995): 215-219. https://www.ncbi.nlm.nih.gov/pubmed/7474275
  21. Anderson OS., et al. “Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation”. Journal of Nutritional Biochemistry 23.8 (2012): 853-859. https://www.ncbi.nlm.nih.gov/pubmed/22749138
  22. Brown RD., et al. “The impact of mandatory fortification of flour with folic acid on the blood folate levels of an Australian population”. The Medical Journal of Australia 194.2 (2011): 65-67. https://www.researchgate.net/publication/49761419_The_impact_of_mandatory_fortification_of_flour_with_folic_acid_on_the_blood_folate_levels_of_an_Australian_population
  23. Yi Y., et al. “Economic burden of neural tube defects and impact of prevention with folic acid: a literature review”. European Journal of Pediatrics 170.11 (2011): 1391-1400. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197907/
  24. Wilson RD. “SOGC Clinical practice Guideline on Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid sensitive congenital anomalies”. Journal of Obstetrics and Gynaecology Canada 37.6 (2015): 534-548.
  25. Czeizel AF and Varga P. “Periconceptional folic acid/multivitamin supplementation and twin pregnancy”. American Journal of Obstetrics and Gynecology 191.3 (2004): 790-794. https://www.ncbi.nlm.nih.gov/pubmed/15467542
  26. Boyles AI., et al. “Safe use of high intakes of folic acid: research challenges and paths forward”. Nutritional Review 74.7 (2016): 469-474. https://www.ncbi.nlm.nih.gov/pubmed/27272334
  27. Choi JH., et al. “Contemporary issues surrounding folic acid fortification initiatives”. Preventive Nutrition and Food Science 19.4 (2014): 247-260. https://www.ncbi.nlm.nih.gov/pubmed/25580388
  28. Morris MS., et al. “Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors”. American Journal of Clinical Nutrition 91.6 (2010): 1733-1744. https://www.ncbi.nlm.nih.gov/pubmed/20357042
  29. Frankenburg FR. “Folate supplementation: is it safe and effective?” Journal of Clinical Psychiatry 70.5 (2009): 767. https://www.ncbi.nlm.nih.gov/pubmed/19552872
  30. Lumley J., et al. “Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects”. Cochrane Database of Systematic Reviews 3 (2000): CD001056. https://www.ncbi.nlm.nih.gov/pubmed/11686974
  31. Harvard Health Publishing. “Folic acid: Too much of a good thing” (2008). https://www.health.harvard.edu/newsletter_article/Folic_acid_Too_much_of_a_good_thing
  32. Quinlivan EP and Gregory JF. “Reassessing folic acid consumption patterns in the United States in 1999-2004 (2007): Potential effect on neural tube defects and overexposure to folate”. American Journal of Clinical Nutrition 86.6 (2007): 1773-1779. https://www.ncbi.nlm.nih.gov/pubmed/18065598
Citation: Emmanuella Solomon and Nicholas A Kerna. “Prospective Guidelines for Folic Acid Supplementation in Periconception Care for the Prevention of Neural Tube Defects”. EC Gynaecology 9.4 (2020): 56-62.

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