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- Title
Neural Tube Defects and Folic Acid: An Obligation for Prevention.
- Authors
Fieggen, K. J.; Fieggen, A. G.
- Abstract
Neural tube defects (NTDs) such myelomeningocele and anencephaly are the commonest major congenital CNS abnormalities with a live birth incidence of 2.5/1000 estimated in 2006 in South Africa. Remarkably, 50-70% of NTDs can be prevented by ensuring optimal maternal folate levels at the time of closure of the neural tube which occurs between day 21 and day 28 post conception. The aetiology of NTD is multifactorial with both genetic and environmental contributions, many of which are directly linked to folate. Women with a family history of NTD, diabetes, obesity and exposure to teratogens, notably sodium valproate are at greater risk. Genetic testing does not currently have a role in the prevention of NTD. Food fortification with folic acid remains the most successful preventative strategy for NTD and has markedly reduced NTD incidence but even in countries where this is mandatory, such as in South Africa, this does not guarantee protective folate levels in all women of child bearing capacity. For this reason, well-established guidelines specify supplementary periconceptual folic acid, either 4 - 5 mg / day for women at high risk or 0.4mg - 0.8 mg / day for those at standard risk. In addition, some recommendations also include an intermediate risk category, advocating a dose of 1mg / day. As folate is an epigenetic modulator, the safety of food fortification and folic acid supplementation has been closely monitored. Initial concerns about increased risk of cancer and autism spectrum disorder have not been realised and folic acid may even be protective of these conditions. Current evidence assessing safety conclusively demonstrates that the benefits of folic acid clearly outweigh any potential risk.
- Publication
Obstetrics & Gynaecology Forum, 2018, Vol 28, Issue 4, p14
- ISSN
1029-1962
- Publication type
Article