Folates for reduction of risk of neural tube defects: using oral contraceptives as a source of folate

Abstract

The evidence that folates reduce the risk of neural tube defects (NTDs) is so compelling that supplementation has been recommended by every relevant authority. The Cochrane Database of Systematic Reviews has determined that folate supplementation should be rated as a Grade 1 recommendation. United States Preventive Health Services Task Force, the US Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC) have all produced clear guidelines for such supplementation. Unfortunately, despite food fortification and targeted public health campaigns promoting folic acid supplementation, periconceptional utilization of folic acid supplements has decreased in the US in recent years. Worldwide, over 300,000 newborns are affected with NTDs every year. NTDs account for 10% of all neonatal mortality. This article will review the risk factors for NTDs and the evidence supporting folate supplementation. It will also describe the remaining problems and outline current ideas to solve them. Finally, new evidence of the effectiveness of adding metafolin to drospirenone-containing oral contraceptives in raising serum and red blood cell folate levels, the rationale for making such an addition, and an estimate of the magnitude of the contribution use of such pills might have on reducing NTDs will be discussed.

Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study

“…Neural tube defects (NTDs) are congenital anomalies that result from failure of the neural tube to close between day 21 to 28 post conception [ 1 – 4 ]. NTDs are contributing to miscarriage, infant mortality, severe congenital abnormalities and serious disabilities and are the second most common congenital anomaly [ 3 , 5 ]. NTDs account for 10% of all neonatal mortality, 10% of the burden of all congenital conditions and these defects are responsible annually for 41,000 deaths and 2.3 million disability-adjusted life years [ 3 , 6 ].…”

“…NTDs are contributing to miscarriage, infant mortality, severe congenital abnormalities and serious disabilities and are the second most common congenital anomaly [ 3 , 5 ]. NTDs account for 10% of all neonatal mortality, 10% of the burden of all congenital conditions and these defects are responsible annually for 41,000 deaths and 2.3 million disability-adjusted life years [ 3 , 6 ]. NTDs are affecting 0.5–2 per 1000 pregnancies and occurring in about 2–3% live births worldwide [ 1 , 7 , 8 ].…”

“…Because of the lower living standard and low antenatal diagnosis and termination of pregnancy [ 9 ]; the incidence of NTDs in developing countries have been reported to be up to fourfold higher than in developed ones [ 10 ]. The lifelong medical and socioeconomic consequences of NTDs in affected children are equally known to be worse in low-resource settings [ 3 ]. A study conducted in Ethiopia reported that hydrocephalus (35.5%) and neural tube defects (27.5%) were the major leading causes of admission to hospitals for surgical procedures among children [ 11 ].…”

“…Neural tube defects have a heterogeneous and multifactorial etiology, including genetic and environmental factors as well as predisposing maternal factors [ 3 , 8 , 12 ]. Among known environmental factors folic acid deficiency is the most common one [ 12 – 14 ].…”

Level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia

“…Foods that are good sources of folic acid include dark green vegetables, potatoes, beans, spinach, lentils, chickpeas, asparagus, broccoli, peas, brussel, sprouts, nuts, corn, liver, yeast, eggs, beans, oranges, banana and a wide range of fruits, as well as kidney beans [1][2][3]11] Folic acid supplement one month before pregnancy and during first trimester of pregnancy could reduce NTDs by 50-70% [1,8,12,13]. Supplementation may also reduce other birth defects such as congenital cardiovascular defects, orofacial defect, limb defects, urinary tract anomalies, down syndrome, congenital hydrocephalus, omphalocele and imperforate anus [7,14,15].…”