Importance of Folic acid in pregnancy to prevent neural tube defects (NTD)
Submitted by Sailaja Byrisetty on Tue, 04/22/2008 - 23:57.
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Next to cardiac abnormalities, neural tube defects are the second most common major congenital disorders. Spina bifida, a type of NTD, is the most common cause of congenital ambulatory disability.
Awareness about the importance of preventing NTD through sufficient folic acid intake during the periconception period has grown over the past 15 years.
Fortunately, the number of infants born with a NTD has declined. In 1997, 7.5 per 10,000 births in Canada were affected by a NTD (approximately 260 births/year), compared to 11.6 per 10,000 births in 1989. This decrease may be explained by an increase in folic acid supplementation and an improvement in prenatal diagnosis of NTDs, with possible pregnancy termination. Some studies also indicate that perinatal folic acid supplementation decreases the occurrence of defects of the heart, urinary tract, limbs, and possibly orofacial clefts.
Infact, half of all birth defects might be prevented if women of childbearing age were to consume adequate amounts of folic acid. Folic acid is required for DNA and RNA synthesis. Although the mechanism by which folic acid affects neural tube development in the fetus is unclear, it is known that it is required in the first 28 days gestation.
Risk factors:
One of the most important modifiable risk factors for NTDs is folic acid intake. Others risk factors include, a past pregnancy complicated by NTD, a family history of a first, second or third degree relative with a NTD-affected pregnancy. Exposure to teratogens, such as excessive alcohol intake and antineoplastic agents, increase the risk for a NTD-affected pregnancy.
Right dose in right time:
From the analysis of the Medical Research council Vitamin Study and other data, a dose response model for folic acid in high-risk women has been extrapolated. Based on this model, women would benefit from a higher intake of folic acid started prior to conception. Indeed, the model estimated that 5 mg of folic acid would prevent 85% of NTDs, whereas 0.4 mg daily would prevent approximately 36%.
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Folic acid dosing recommendations |
Risk factors |
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0.4 mg-1 mg Folic acid daily |
Women who could become pregnant |
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Women planning pregnancy—start 2 to 3 months prior to |
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4-5 mg Folic acid daily |
High risk for NTDs |
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Previous pregnancy affected by NTDs or orofacial clefts |
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Family history of NTDs |
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Diabetes |
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Epilepsy |
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Women taking anti-epileptic medications (Carbamazepine, valproic acid) |
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Women taking antifolates (methotrexate,sulfonamides) |
Dietary sources of folic acid:
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>55 Fg of folate per serving |
>33Fg of folate per serving |
>11Fg of folate Per serving |
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Chick peas Lentils Cooked kidney/soy/roman/ pinto/fava/white beans Cooked spinach,asparagus Orange juice Canned pineapple juice Sunflower seeds Romaine lettuce |
Cooked lima beans Corn Bean sprouts Cooked broccoli Green Peas Beets Raspberries Blackberries Avocado Roasted peanuts Wheat germ |
Cooked carrots Sweet potato Snow peas Cabbage Cooked green beans Cashews,walnuts Strawbetties Bananas Grapefruit Cantaloupe Whole wheat and white |
Note: 100 Fg = 0.1 mg folic acid.
Source : Canadian Pharmacists Journal
Prevention is better than cure
It really is a case that people often overlook health unless they fall ill, why they do not turn to preventive medicine. Infact the medical and pharma professionals should try to divert the mind of everyone to go for preventive medicine as "prevention is better than cure".
People overlook because.....
I agree with you that people always overlook their health, but why? I don't blame them. I blame health organizations who are responsible for public health. Why don't they increase the awareness of such things ? There are many simple issues make lot of difference in once life, such as, using Calcium and Vitamin D well in advance would possibly prevent Osteoporosis, taking folic acid 6 months before planning to have pregnancy would probably prevent having baby with down syndrome for example, having regular general check ups for bone density, cholesterol , asking women to check their brests periodically for any lumps to diagnise breast cancer in advance stage, informing the importance of breast milk to new mothers etc.. by their family doctors would probably prevent fsuffering from any major diseases. So, as you said, medical and pharma professionals should try to educate people as much as possible and increase the awareness because "Prevetion is better than cure" for sure.