PREGNANCY
FOLIC ACID SUPPLEMENTS ARE MORE EFFECTIVE THAN INCREASED
DIETARY FOLATE INTAKE IN ELEVATING SERUM FOLATE LEVELS
In 1992 the Department of Health advised that to prevent
the first occurrence of a neural tube defect all women should
increase their folate consumption by 400mg in the periconceptional
period. This was to be achieved by increasing consumption
of folate-rich foods or taking a daily 400mg folic acid
supplement. However, a recent study found that only one-quarter
of women with an uncomplicated obstetric history and 51%
with a complicated obstetric history took supplements for
the recommended time period. Dietary modification was found
to be extremely unusual. Serum analysis demonstrated that
intake of folic acid supplements provides a greater elevation
in serum folate levels than dietary food intake.
This suggests that dietary manipulation is an ineffective
strategy and that efforts would be better focused on increasing
supplement intake at a clinically important time. More effective
education strategies are required, and since approximately
one-third of pregnancies are unplanned, fortification of
foods with folic acid is warranted.
Elkin, A.C. and Higham, J.
BJOG 2000, 107 (2) 285-9
NEURAL TUBE DEFECTS AND PERICONCEPTIONAL FOLIC ACID
Authors of this retrospective study assessed whether there
had been any change in the incidence of neural tube defects
since 1992, when the Expert Advisory Group in the UK recommended
that women who were trying to conceive should take 0.4mg
folic acid per day.
They found that before 1992 there was a significant drop
in the incidence of neural tube defects, but that since
1992 the rates of decline have stabilised and become significantly
less rapid than before 1992. The number of prescriptions
of folic acid dispensed increased between 1990 and 1996,
and over the counter sales increased between 1990 and 1994
and declined in 1995-6.
The authors speculate that perhaps women may not be taking
supplements at the right time, or the dose may be too low,
or the supplements may not be taken by those at the highest
risk, as periconceptional supplementation with folic acid
has been shown to be effective in randomised controlled
trials.
Kadir et al
BMJ no 7202 10th July 1999
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