Last week a pregnant woman came into our pharmacy and said that her physician recommended for her to take folic acid tablets daily along with her prenatal multivitamin. This led me to do some investigating.

In the past, the general recommendation has been for all women of child bearing age to take 0.4mg of folic acid for the prevention of neural tube defects in case the woman becomes pregnant. If a woman becomes pregnant, she is often instructed to increase her intake to 1mg of folic acid which is the amount in most prenatal multivitamins. As I looked into this issue, I discovered that new guidelines are now suggesting that some women should get even more folic acid. I also learned that the benefits of folic acid go beyond preventing neural tube defects.

The new guidelines for folic acid intake in pregnancy were published by the Society of Obstetricians and Gynaecologists of Canada and The Motherisk Program in December 2007. These recommendations divide patients into 3 groups:

1. Women who have no health risks, planned pregnancy and a good diet of foods rich is folic acid should take a multivitamin with 0.4 to 1mg of folic acid for at least 2 to 3 months before conception and continue postpartum for 4-6 weeks or as long as they are breastfeeding.
2. Women who have health risks like epilepsy, diabetes, obesity, a family history of neural tube defects or belong to a high-risk ethnic group should take a multivitamin with 5mg of folic acid for at least 3 months before conception and continue for 10 to 12 weeks post-conception. At that time they can then they can reduce their intake to a multivitamin with 0.4mg to 1mg of folic acid until 4 to 6 weeks postpartum or as long as they continue breastfeeding.
3. Women who have a poor compliance with medications and have a variable diet, no consistent birth control and consume possible teratogenic substances like alcohol or tobacco require a multivitamin with 5mg folic acid.

It has been known for a long time that folic acid is important in preventing neural tube defects, so I was interested to find a new study that showed that folic acid may also reduce preterm labour. This study was revealed at the annual Society for Maternal-Fetal Medicine (SMFM) meeting in Dallas. The study looked at nearly 40 000 women and showed that the women who took folate supplements for at least 1 year prior to their pregnancy had a 70% decrease in very early preterm deliveries (20 to 28 weeks) and up to a 50% decrease in early preterm deliveries (28-32 weeks). This study gives women another reason why it is so important to take folic acid.

Links:
Joint SOGC-Motherisk Clinical Practice Guideline
New guidelines boost folic acid recommendation (Globe and Mail)
Folic acid can cut risk of premature birth (CTV)
Folic Acid May Help Prevent Premature Birth (Washington Post)