Folic acid for the block of neural tube defects

Folic acid for the block of neural tube defects

In 1992, the U.S. Public Health Service recommended that adult females of childbearing age take folic acid supplements to reduce the incidence of neural tube defects, which occur in about 1 in 1000 pregnancies. Later, the Food and Drug Administration began requiring that enriched grain products be fortified with folic acid. Ten years afterwards, the incidence of neural tube defects had declined, though there was little alteration in the percentage of adult females of childbearing age (25-30%) who reported taking folate supplements on a regular basis, as AFP reported in a Clinical Brief. A more recent survey taken in Canada found that 22% of women of childbearing age have red blood cell folic acid concentrations that are considered suboptimal for neural tube defect prevention.

The December 15th issue of AFP features the U.S. Preventive Service Task Force's updated recommendation statement on folic acid for the prevention of neural tube defects, along with a Putting Prevention Into Practice case study. Knowing that a significant proportion of pregnancies are unplanned, the USPSTF gives an "A" grade to the recommendation that "all women planning or capable of pregnancy require a daily supplement containing 0.4 to 0.8 mg (400 to 800 microgram) of folic acid." (You can get more information about preconception and prenatal issues in AFP's Prenatal Care collection.)

USPSTF recommendations are written for primary care clinicians, but it is comparatively uncommon for patients presenting specifically for preconception care visits, where they can receive education about the demand to consider folic acid supplements. What alternative strategies does your practice exercise to inform patients about these and other important preventive health needs, such as healthy eating and exercise, that wouldn't necessarily bring them into the government agency?