Pregnancy

Folic acid supplementation in pregnancy

The neural tube wherein the brain and spinal cord developed is formed during the first four weeks of fetal life. Yet, in some cases where the cause is unknown but genetics and environmental factors are thought to be simultaneously effective, neural tube formation cannot be properly completed and severe congenital anomalies known as neural tube defects (NTD) such as anencephaly, encephalocele, meningocele, myelocele, spina bifida emerge. Anencephalic babies die soon after birth. Other NTDs cause life-long disabilities.  The cost of life-long care for a child with NTD is estimated about $ 532,000 in the United States, not to mention the emotional burden on the families
 NTD is among the most prevalent congenital anomalies. A survey conducted in Turkey reveals the prevalence of NTD as 3 per thousand. It is stated that this ratio is 1 in Europe and 2 in the USA. The likelihood of having NTD in the second child of a couple parenting a child with NTD is around 2 or 3%. It is also thought that an unknown number of pregnancies have also been resulted in miscarriage due to NTD. 

Recent research studies indicate that NTDs can be reduced by 70% with 0.4 mg daily folic acid intake in the first trimester of pregnancy, starting before the pregnancy.  

Principally, primary health care staff and managers are in charge of applying the necessary practices to prevent NTDs.  

Recommendations 

As the NTD prevalence in Turkey is relatively high, folic acid supplementation in pregnancy is expected to be an important contribution to reduce the prevalence. The following measures are beneficial to reduce NTD prevalence in Turkey. 
*All couples who have infants with NTD or NTD family history should be informed about  folic acid supplementation before a new pregnancy. Genetic counseling should be given at this period and the future mother should start taking 4 or 5 mg folic acid daily. 
*All women planning for a pregnancy in the near future should take 0.4 mg folic acid daily during the period of conception. Considering that 40% of pregnancies in Turkey are unplanned, this goal might be difficult to achieve.

References

1- Turan JM et al. Nöral Tüp defektlerinin folik asit kullanımı. STED.2000
2- American Academy of Pediatrics, Policy statement. Folic acid for the prevention of neural tube defects. Pediatrics September 1993;92(3):493-4 
3- Aydınlı K, Cajdas A, Kayserili H ve ark. The effect of preconceptional folic acid treatment on the recurrence risk of nonsyndromic neural tube defects. Balk J of Med Genet 1998;1(3): 120-4 
4- Berry RJ, Li Z, Erickson D, et al. Prevention of neural-tube defects with folic acid in China. N Engl J Med 1999; 341 (20): 1485-90 
5- Centers for Disease Control. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 1992; 41 (No.RR-14): 1-7 
6- Friel JK, Frecker M, Frase FC. Nutritional patterns of mothers of children with neural tube defects in Newfoundland. Am J Med Genet 1995; 55: 195-9
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