Folic Acid Consumption throughout Pregnancy – Differentiation between Trimesters

Abstract

Intervention trials have demonstrated conclusively that oral ingestion of extra folic acid can prevent the majority of cases of spina bifida and other neural tube defects (NTDs). Data from these studies offer conclusive evidence that the intake of 400 µg/day folic acid provides this benefit. The big problem has remained that the neural plate closes to form the neural tube between day 21 and day 28 postconception, at which point most women do not even realize that they are pregnant. This, coupled with the fact that over half of all pregnancies are unplanned, has resulted in many studies showing that less than one-fifth of pregnancies have followed the recommendation for prevention. However, where compliance has been good or where folic acid has been added mandatorily, there has been the expected reduction in NTDs. Clarity regarding what is recommended for early pregnancy does not carry through to the second or third trimester of pregnancy where practices vary widely not only from country to country but even from clinician to clinician within particular countries.

Apoptosis, Expression of PAX3 and P53, and Caspase Signal in Fetuses with Neural Tube Defects

“…In this study, 20 to 26% of cases were the results of unintended pregnancies compared with 57 to 95% of controls. Unintended pregnancies are associated with failure of folic acid supplementation (Scott, ).…”

Preventive Effects of Folic Acid Supplementation on Adverse Maternal and Fetal Outcomes

“…These findings inform that the study pregnant women followed their physician’s recommendations well, so they should be encouraged to consume folic acid or informed about its beneficial role. It is well known that fewer than 20% of women comply with folic acid supplementation during early pregnancy, and more than half of pregnancies are unintended or unplanned [13] , [14] . Moreover, there is variability in the recommended amount and duration of folic acid supplementation between countries and clinicians.…”

Prevention of spina bifida: folic acid intake during pregnancy in Gulu district, northern Uganda

“…25.5% in Nigeria [ 29 ], and 53% in Congo [ 30 ]. With 17.3% of the Ugandan women in our study taking folic acid supplements during the first trimester of pregnancy, the percentage is slightly lower than the worldwide estimate of only 20% of pregnant women being able to follow the recommendation of folic acid intake for prevention [ 31 ]. Whilst peri-conceptional intake of folic acid supplements was 17.2% in Tanzania [ 32 ], our study population did not report any early intake of supplements.…”