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User:Madiqw/Neural tube defect

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Prevention

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Incidence of neural tube defects has been shown to decline through maintenance of adequate folic acid levels prior to and during pregnancy. This is achieved through dietary sources and supplementation of folic acid.[1] In 1996, the United States Food and Drug Administration published regulations requiring the addition of folic acid to enriched breads, cereals, flour and other grain products.[2] Similar regulations made it mandatory to fortify selected grain products with folic acid in Canada by 1998.[3] It is important to note that during the first four weeks of pregnancy (when most people do not even realize that they are pregnant), adequate folate intake is essential for proper operation of the neurulation process. Therefore, any individuals who could become pregnant are advised to eat foods fortified with folic acid or take supplements in addition to eating folate-rich foods to reduce the risks of serious birth defects.[4][5][6] In Canada, mandatory fortification of selected foods with folic acid had been shown to reduce the incidence of neural tube defects by 46% compared to incidence prior to mandatory fortification.[7] However, relying on eating a folate-rich diet alone is not recommended for preventing neural tube defects when trying to conceive because a regular diet usually does not contain enough folate to reach pregnancy requirements.[8][9] All individuals who have the ability to become pregnant are advised to get 400 micrograms of folic acid daily.[10][11] This daily 400 mcg dose of folic acid can be found in most multivitamins advertised as for women[12]. Higher doses can be found in pre-natal multivitamins but those doses may not be necessary for everyone.[13][14] Individuals who have previously given birth to a child with a neural tube defect and are trying to conceive again may benefit from a supplement containing 4.0 mg daily, following advice provided by their doctor.[12] In Canada, guidelines on folic acid intake when trying to conceive is based on a risk assessment of how likely they are to experience a neural tube defect during pregnancy. Risk is divided into high, moderate, and low risk categories.[11] High risk would include those that had a past experience with neural tube defects, either themselves or during another pregnancy. [11] Medium risk individuals are those with certain conditions that put them at higher risk for experiencing a neural tube defect. These include having a first or second degree relative or partner with a history of neural tube defects, having a gastrointestinal condition that affects normal absorption patterns, advanced kidney disease, kidney dialysis, alcohol over-use, or had another pregnancy resulting in a congenital abnormality that was folate sensitive. Medium risk individuals would also include those taking medications that can interfere with folate absorption such as anticonvulsants, metformin, sulfasalazine, triamterene, and trimethoprim.[11] Low risk would include everyone else that do not fall into either medium or high risk categories. Recommendations on when to start folic acid supplementation for all individuals looking to become pregnant is at least 3 months preconception.[9][11] If an individual is in the high risk category, the recommended dose is 4-5 mg of folic acid daily until 12 weeks gestation and then decrease to 0.4-1 mg until 4-6 weeks postpartum or for however long breastfeeding lasts. [11] If an individual is in the medium risk category, the recommended dose is 1 mg of folic acid daily until 12 weeks gestation and then they can either continue at 1 mg or decrease to 0.4 mg daily until 4-6 weeks postpartum or however long breastfeeding lasts.[11] If the pregnancy is low risk to develop a neural tube defect then the recommendation for that individual is 0.4 mg daily until 4-6 weeks postpartum or however long breastfeeding lasts.[11] All dose recommendations and risk assessment should be done with the advice of a qualified health care provider.[10]

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  1. ^ De Wals, Philippe; Tairou, Fassiatou; Van Allen, Margot I.; Uh, Soo-Hong; Lowry, R. Brian; Sibbald, Barbara; Evans, Jane A.; Van den Hof, Michiel C.; Zimmer, Pamela; Crowley, Marian; Fernandez, Bridget (2007-07-12). "Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada". New England Journal of Medicine. 357 (2): 135–142. doi:10.1056/NEJMoa067103. ISSN 0028-4793.
  2. ^ Daly S, Mills JL, Molloy AM, Conley M, Lee YJ, Kirke PN, Weir DG, Scott JM (1997). "Minimum effective dose of folic acid for food fortification to prevent neural-tube defects". Lancet. 350 (9092): 1666–69. doi:10.1016/S0140-6736(97)07247-4. PMID 9400511. S2CID 39708487.
  3. ^ Ray, Joel G. (2004-06-01). "Folic Acid Food Fortification in Canada". Nutrition Reviews. 62 (6): 35–39. doi:10.1301/nr.2004.jun.S35-S39.
  4. ^ Greene, ND; Stanier, P; Copp, AJ (2009). "Genetics of human neural tube defects". Human Molecular Genetics. 18 (R2): R113–29. doi:10.1093/hmg/ddp347. PMC 2758708. PMID 19808787.
  5. ^ Milunsky A, Jick H, Jick SS, Bruell CL, MacLaughlin DS, Rothman KJ, Willett W (1989). "Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects". Journal of the American Medical Association. 262 (20): 2847–52. doi:10.1001/jama.262.20.2847. PMID 2478730.
  6. ^ Goh, YI; Koren, G (2008). "Folic acid in pregnancy and fetal outcomes". J. Obstet. Gynaecol. 28 (1): 3–13. doi:10.1080/01443610701814195. PMID 18259891. S2CID 28654601.
  7. ^ De Wals P, Tairou F, Van Allen MI, et al. (2007). "Reduction in neural-tube defects after folic acid fortification in Canada". N Engl J Med. 357 (2): 135–42. doi:10.1056/NEJMoa067103. PMID 17625125.
  8. ^ Naithani, Manisha; Saxena, Vartika; Mirza, Anissa Atif; Kumari, Ranjeeta; Sharma, Kapil; Bharadwaj, Jyoti (2016). "Assessment of Folic Acid Supplementation in Pregnant Women by Estimation of Serum Levels of Tetrahydrofolic Acid, Dihydrofolate Reductase, and Homocysteine". Scientifica. 2016: 1–5. doi:10.1155/2016/1520685. ISSN 2090-908X. PMC 4811260. PMID 27064332.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  9. ^ a b Canada, Health (2009-04-28). "Prenatal Nutrition Guidelines for Health Professionals - Folate Contributes to a Healthy Pregnancy". www.canada.ca. Retrieved 2021-12-01.
  10. ^ a b Canada, Public Health Agency of (2018-01-05). "Folic acid and neural tube defects". www.canada.ca. Retrieved 2022-02-27.
  11. ^ a b c d e f g h Wilson, R. Douglas; Wilson, R. Douglas; Audibert, François; Brock, Jo-Ann; Carroll, June; Cartier, Lola; Gagnon, Alain; Johnson, Jo-Ann; Langlois, Sylvie; Murphy-Kaulbeck, Lynn; Okun, Nanette (2015-06-01). "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): 534–549. doi:10.1016/S1701-2163(15)30230-9. ISSN 1701-2163.
  12. ^ a b Centers for Disease Control (11 September 1992). "Recommendations for the Use of Folic Acid to Reduce the Number of Cases of Spina Bifida and Other Neural Tube Defects". Morbidity and Mortality Weekly Report. 41 (RR-14): 001.
  13. ^ CDC (2021-04-19). "Folic Acid". Centers for Disease Control and Prevention. Retrieved 2022-02-27.
  14. ^ Canada, Health (2009-04-28). "Prenatal Nutrition Guidelines for Health Professionals - Folate Contributes to a Healthy Pregnancy". www.canada.ca. Retrieved 2022-02-27.
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