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Folic acid supplementation and neural tube defect recurrence prevention

Authors

  • Scott D. Grosse,

    Corresponding author
    1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
    • National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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  • Julianne S. Collins

    1. JC Self Research Institute, Greenwood Genetic Center, Greenwood, South Carolina
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  • This article is a US Government work and, as such, is in the public domain in the United States of America.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Center for Disease Control and Prevention.

Abstract

BACKGROUND:

It is well established that women who have had a pregnancy affected by a neural tube defect (NTD) have an elevated risk of a subsequent NTD-affected pregnancy and that a high dose (4 mg/day) of folic acid taken around the time of conception prevents most recurrences of NTDs.

METHODS:

We reviewed the literature to identify studies that quantify the reduction in risk if women with a prior-NTD affected pregnancy consistently take folic acid before and during a subsequent pregnancy and the effectiveness of NTD recurrence prevention programs in increasing the percentage of women who consistently consume folic acid supplements.

RESULTS:

A meta-analysis of randomized trials of folic acid for the prevention of recurrent NTDs indicates a 69% reduction in recurrence risk if analyzed on an intention-to-treat basis and an 87% reduction among those women who took supplements prior to the beginning of pregnancy. Observational studies report reductions in recurrence risk of 85% to 100% among women taking folic acid prior to subsequent pregnancies. The percentage of women who take folic acid prior to a subsequent pregnancy has been reported to vary from 33% to 85%, varying with the demographic background and the intensity of folic acid counseling efforts.

CONCLUSIONS:

Targeted folic acid information and counseling provided to women with an NTD-affected pregnancy has been demonstrated to substantially reduce the risk of recurrent NTDs and is feasible to implement on a public health basis. Birth Defects Research (Part A) 79:737–742, 2007. © 2007 Wiley-Liss, Inc.

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