A review of European guidelines on periconceptional folic acid supplementation

Abstract

Strong evidence that folic acid (FA) prevents the majority of cases of neural tube defects (NTDs) has led to national organisations developing guidelines for women concerning periconceptional supplementation. In Europe, there is evidence of national variations in the incidence of NTDs, with a recent Irish study reporting an increase in the rate. This review compares the periconceptional FA supplementation guidelines between the different countries in Europe. An online search of country-specific guidelines produced before 2015 concerning periconceptional FA supplementation was conducted. If an English version was not available directly, the EUROCAT register was searched for the English version of the recommendations. We identified national guidelines from 20 European countries. Over half recommended that FA supplements be taken by women planning a pregnancy, but three recommended that they should be taken by all women of child-bearing age. Four guidelines recommended starting FA at least 4 weeks preconceptionally, but no country recommended starting FA at least 12 weeks preconceptionally as suggested by recently published studies. There is a need for further consideration of the duration of preconceptional FA supplementation specifically. The latest scientific evidence in this area should inform the development of European guidelines on FA, as there is wide variation in current recommendations. Overall, the wide variation in national guidelines concerning periconceptional FA supplementation may in part explain the differences in national rates of NTDs reported by EUROCAT. National guidelines on FA supplementation should be standardised across European countries.

Ethnic differences in folic acid supplement use in a population-based cohort of pregnant women in Norway

“…Fourthly, parous women should be reminded during late antenatal or postpartum visits about the importance of folic acid supplement use before possible subsequent pregnancies. Additionally, a potential, but controversial option would be to consider food fortification with folate as some authors have suggested [9]. …”

“…Recommendations for peri-conceptional folic acid supplementation vary in Europe [9]. In Norway, all women planning a pregnancy or who may become pregnant, are recommended to use folic acid supplements (0.4 mg/day) at least from one month before conception until three months gestation [10].…”

Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document

“…Maternal supplementation with folic acid is widely recommended to all women of childbearing age, especially to reduce the risk of neural tube defects [66,67]. According to recent studies, folic acid supplementation during pregnancy should also reduce the risk of congenital heart disease and support proper development of the placenta [68].…”

How Does Folic Acid Supplementation Affect Serum Folate Concentrations in Pregnant Turkish Women?

“…This recommendation is based on clinical experience, descriptive studies, or reports of expert committees rather than on properly randomized controlled trials. That is, the opinions of respected authorities have been considered satisfactory enough to recommend folic acid supplementation in women of childbearing age [13,14]. The aforementioned guidelines also emphasize that folic acid/ multivitamin supplementation is needed to achieve the serum concentrations that are required to provide protection against neural tube defects.…”