Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects
Background and objectives: Neural tube defects arise during the development of the brain and spinal cord. The objective of this review was to assess the effects of increased consumption of multivitamins or folate on the prevalence of neural tube defects before pregnancy and in the first two months of pregnancy (periconceptionally).
According to Evidence Based Medicine (EBM) :-
In 6425 women included, all the trials addressed the question of supplementation and they were of variable quality. No dissemination trials were identified. Periconceptional folate supplementation reduced the incidence of neural tube defects (odds ratio 0.28, 95% confidence interval 0.15 to 0.53). Folate supplementation did not significantly increase spontaneous abortion, ectopic pregnancy or stillbirth, although there was a possible increase in multiple gestation. Multivitamins alone were not associated with prevention of neural tube defects and did not produce preventive effects when given with folate.
Conclusions: Periconceptional folate supplementation has a strong protective effect against neural tube defects. Information about folate should be made more widely available throughout the health and education systems. Women whose fetuses or babies have neural tube defects should be offered continuing folate supplementation. The benefits and risks of fortifying basic food stuffs, such as flour, with added folate remain unresolved.
Further readings:-
Locksmith GJ; Duff P. Preventing neural tube defects: the importance of periconceptional folic acid supplements. Obstet Gynecol, 1998 Jun, 91:6, 1027-34
Barber RC; Lammer EJ; Shaw GM; Greer KA; Finnell RH . The role of folate transport and metabolism in neural tube defect risk. Mol Genet Metab, 1999 Jan, 66:1, 1-9
Czeizel AE; Dudلs I Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation N Engl J Med, 1992 Dec, 327:26, 1832-5
Wald NJ; Hackshaw AD; Stone R; Sourial NA Blood folic acid and vitamin B12 in relation to neural tube defects. Br J Obstet Gynaecol, 1996 Apr, 103:4, 319-24