Periconceptional folic acid supplementation for primary prevention



One of the most remarkable developments in the field of teratogenesis during last two decades has been demonstration of efficacy of periconceptional folic acid supplementation in prevention of NTD. In UK, it has shown that periconceptional folic acid supplementation has reduced the risk of NTDs by 70%. Its efficacy in Indian population has also been demonstrated. The timing of folic acid supplementation for prevention of NTD is very critical. The US public health service recommended that all woman of childbearing age should consume 400 mg (0.4mg) of folic acid every day, to reduce their risk of having NTD affected pregnancy. The folic acid supplementation ideally should be started 3 months before and continued till 3 months after pregnancy. It is very difficult to know for a woman when she will become pregnant. So all women capable of becoming pregnant; not just those planning a pregnancy should consume enough folic acid every day. As an alternative, it has been proposed to fortify breakfast cereals and bread to provide the recommended daily allowance of folic acid.

Secondary prevention
Secondary prevention includes the screening and the options of selective termination of pregnancy. Some embryo with NTD will be aborted spontaneously. By mid-pregnancy, it can be expected that almost all cases of anencephaly, at least two third of those with Spina Bifida will be identified by estimation of alfa Fetoprotein levels in maternal blood and amniotic fluid and by ultrasound. Some parents choose to have the pregnancy terminated at this stage.

Prevalence of the NTDs is significantly influenced by the effectiveness of maternal blood and amniotic fluid examination and by ultrasound. Some parents choose to have the pregnancy terminated at this stage.

Methods of improving folic acid Intake
There are three ways from which women can get enough folic to prevent spina bifida.

They can choose to -

• Take vitamin supplement containing 400 micrograms folic acid daily.
  
  
• Eat fortified breakfast cereals daily, which contain 100% of the recommended daily amount of folic acid.
  
  
• Increase consumption of food fortified with folic acid (e.g. enriched cereals, bread, rice grains etc.) in addition to consuming food folate from variety of diets. (e.g. Orange juice and vegetables.)

Taking a vitamin supplementation containing folic acid is an easy way to get enough folic acid. Synthetic folic acid is absorbed better than natural food folate.