Ácido fólico na prevenção de gravidez acometida por morbidade fetal: aspectos atuais

Os estudos em paises desenvolvidos sugerem uma tendencia a reducao da incidencia e gravidade dos defeitos abertos do tubo neural (DATN), apos a adocao de programas de fortificacao de graos e farinaceos. No Brasil, a mesma tendencia foi observada, porem nao com a mesma intensidade, decorrente da diversidade dos habitos alimentares regionais, inferindo que apenas a adocao do programa de fortificacao nao seja suficiente para haver reducao significativa dos DATN. O papel do acido folico na prevencao de malformacoes do tubo neural esta bem definido. A prevencao de cardiopatias, malformacoes faciais e cromossomopatias ainda permanece incerta, sendo necessarios estudos para avaliar a acao do micronutriente na profilaxia de outras morbidades fetais. Constatou-se aumento do conhecimento de pacientes e profissionais de saude envolvidos na assistencia pre-natal sobre o papel do acido folico e, em particular, no seu uso periconcepcional especialmente em paises desenvolvidos. Assim, apesar dos programas de fortificacao implantados em alguns paises desenvolvidos terem sido eficientes em reduzir de forma significativa a incidencia dos DFTN, no Brasil, precisam-se considerar as variacoes regionais e promover melhor a suplementacao farmacologica do acido folico periconcepcional Studies in developed countries have suggested a tendency of reduction in incidence and severity of neural tube defects (NTD), after the adoption of folic acid food fortification programs. In Brazil, the same trend was observed; however not with the same intensity. This finding seems to be associated with the great diversity of the Brazilian regional alimentary habits, leading some researchers to infer that only foods fortification programs are not enough to reach a significant reduction of NTD incidence. The knowledge of folic acid prevention of NTD malformations is well-established by consistent publications. It is not completely clear the folate role in preventing congenital cardiopathies, facial malformations and cromossomic disorders. An increase in patients and physicians' knowledge about folic acid role in the prevention of NTD malformations was noticed. Its periconceptional use has increased more significantly especially in developed countries. Although food fortification programs in some developed countries have been efficient in reducing significantly the incidence and severity of NTD malformations, in Brazil, the program must consider regional variations and improve folate promotion for medical supplementation in periconceptional folic acid