Wednesday, December 22, 2010

Folic acid for the prevention of neural tube defects

In 1992, the U.S. Public Health Service recommended that women of childbearing age take folate supplements to reduce the incidence of neural tube defects, which occur in about 1 in 1000 pregnancies. Subsequently, the Food and Drug Administration began requiring that enriched grain products be fortified with folic acid. Ten years later, the incidence of neural tube defects had declined, though there was little change in the percentage of women of childbearing age (25-30%) who reported taking folate supplements on a regular basis, as AFP reported in a Clinical Brief. A more recent study conducted in Canada found that 22% of women of childbearing age have red blood cell folate 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. Recognizing that a substantial proportion of pregnancies are unplanned, the USPSTF gives an "A" grade to the recommendation that "all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid." (You can find more information about preconception and prenatal issues in AFP's Prenatal Care collection.)

USPSTF recommendations are written for primary care clinicians, but it is relatively rare for patients to present specifically for preconception care visits, where they can receive education about the need to take folic acid supplements. What alternative strategies does your practice use 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 office?