New guidelines for folic acid in pregnancy

The Society of Obstetricians and Gynaecologists of Canada(SOGC)and the Motherisk Program jointly released updated clinical guidelines on folic acid supplementation for women planning to have children. Folic acid has been well known to prevent neural tube defects(NTDs)in babies. New evidence also suggests folic acid supplementation reduces the incidence of congenital heart disease, urinary tract problems, oral facial clefts, limb defects, and some pediatric cancers. Some women, however, will need 5 mg of folic acid daily, rather than the 1mg included in most prenatal vitamins. Women planning to become pregnant should increase their intake of folic acid and add a multi-vitamin supplement at least three months before they conceive. If women wait until they have a positive pregnancy test before starting supplementation, it will be too late to reap the full protective benefit folic acid can provide. Folic acid helps produce and maintain new cells, and is important during the early embryonic and fetal periods when rapid cell division and growth are occurring.

Dosage recommendations

Women with no personal health risks, planned pregnancy, and good compliance require a good diet of folate-rich foods and a daily supplementation with a multivitamin with folic acid(0.4–1.0 mg)for at least two to three months before conception and throughout pregnancy and during the postpartum period(4–6 weeks and as long as breastfeeding continues).

Women with compromised health, insulin dependent diabetes, obesity, or those with a previous child in the family with a neural tube defect require increased dietary intake of folate-rich foods and daily supplementation, with multivitamins with 5 mg folic acid, beginning at least three months before conception and continuing until 10 to 12 weeks post conception. From 12 weeks post-conception and continuing throughout pregnancy and for four to six weeks after the baby is born(or as long as breastfeeding continues), supplementation should consist of a multivitamin with folic acid(0.4–1.0 mg).

Women with a variable diet, no consistent birth control, and possible substance use should be counseled regarding prevention of birth defects and health problems via folic acid and multivitamin supplementation and it is recommended that they also receive folic acid 5 mg with a multivitamin.

All women should be counseled not to take more than the daily recommended dosage of multivitamin indicated on the product label.

Foods that are a good source of folic acid include fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, Brussels sprouts, corn, and oranges. However, it is unlikely that diet alone can provide the levels recommended for those planning to have children.

The Guidelines also urge the federal government to consider nearly doubling the level of folic acid fortification currently applied to a range of flour products. This recommendation is controversial in view of recent findings that high levels of folic acid in older people appear to lead to an increased risk of bowel cancer. In 1998 Canada added folic acid to white flour, pasta and cornmeal. An increase in bowel cancer was seen corresponding to these changes. The U.S. also reported an increase in bowel cancer rates when they fortified nutritional products with folic acid. The U.K. has put their decision to fortify food products on hold in view of these reports.

Reference:

Society of Obstetrics and Gynecology of Canada. Media Advisory. New Recommendations May Significantly Reduce Birth Defects in Canada. www.sogc.org/media/advisories-20071212_e.asp(accessed December 13, 2007)

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