‘Government recommendation is clear’: Statement published in JAMA supports folic acid supplementation for healthy pregnancy

11-Jan-2017 - Last updated on 11-Jan-2017 at 16:24 GMT

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Even in the era of mandatory fortification, experts back the need of folic acid supplementation among women of childbearing age.

The statement was prepared by the US Preventive Services Task Force and published yesterday online in The Journal of the American Medical Association (JAMA).

“This recommendation reaffirms the 2009 recommendation statement on folic acid supplementation in women of childbearing age,” the report said. “The current statement recommends that all women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400-800 µg) of folic acid.”

Folic acid has been observed to help prevent neural tube defects (NTD) when taken at sufficient amounts by women before and during pregnancy. “Randomized and observational studies suggest that taking folic acid significantly decreases the risk of fetal neural tube defects, particularly in women whose diets are not high in folic acid,” the task force wrote.

Build-up concerns? Supplementation still necessary even with mandatory fortification, says expert

An opinion piece on the folic acid recommendation, published in the same issue of JAMA, supported supplementation in addition to mandatory folic acid fortification of grain products, a strategy which came into effect in the US in 1998 and is now adapted in 80 countries.

Written by Dr James Mills MD, Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, he argued that though there is concern of adverse effects from exposure to high doses of folic acid due to mandatory fortification in grain products, “the data published to date do not confirm any of these harms" (which includes increased risk of cancer, asthma, autism, and cognitive problems) with the exception of masking of vitamin B12 deficiency anemia in elderly persons.

Eating fortified foods and taking supplements should go hand-in-hand, he suggests. For the importance of fortification, he cited two studies, one published in Epidemiology in 2011 and another in the American Journal of Epidemiology in 2009, that suggest food fortification at the “current modest level is preventing most, if not all, folate-related NTDs.”

Depsite this, Dr Mills said “too little is known about how folic acid prevents NTDs. For example, it is not known whether the tissue stores of folate in the developing embryo or the availability of folate in the serum during the all-important few days of neural tube closure is most important.”

“Habitual use of folic acid supplements is a more reliable method of ensuring adequate levels than diet,” he added. “In theory, a woman might not consume sufficient enriched cereal grains during the critical period of approximately 1 week when the neural tube is closing. Exactly when folate must be available also is not known. In addition, some popular diets, such as low-carbohydrate or gluten-free, may reduce exposure to grains, limiting folic acid intake.”

CRN: An applause and a push to include supplement purchase using SNAP

The Council for Responsible Nutrition (CRN), in a press release, commended the USPSTF’s recommendation that all women of child-bearing age supplement with folic acid.

“Even in the era of food fortification, essential nutrients needed for optimal health are not always easily attained through diet alone, something acknowledged in the USPSTF report,” said Duffy MacKay, ND, senior vice president, scientific, and regulatory affairs at CRN, in an official statement.

“With this strong recommendation for folic acid supplements, the next logical step is to include multivitamins with folic acid within all government nutrition programs, including Supplemental Nutrition Assistance Programs (SNAP),” he added.

“This will ensure that reproductive-age women looking to the government for nutritional assistance will have access to the protective effects of folic acid during pregnancy. Low-income mothers should have the choice to use their SNAP benefits to purchase a multivitamin with folic acid. Furthermore, a multivitamin provides other nutrients, such as iodine, that are critical for a healthy pregnancy.”