Orofacial Clefts in High Prevalence Area of Birth Defects — Five Counties, Shanxi Province, China, 2000–2020
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Folic acid supplementation
(Abstracted from JAMA 2017;317(2):190–203) Neural tube defects (NTDs) are among the most common congenital anomalies reported in the United States, and periconceptional folic acid supplementation has been found to decrease the recurrence risk of NTDs. The primary aim of this US Preventive Services Task Force study was to review the existing data on use of folic acid supplementation for preventing NTDs and to provide an updated/revised recommendation statement.
Folic acid supplementation
Task force
Neural tube defect
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Primary Prevention
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The benefits of periconceptional folic acid supplementation in prevention of neural tube defects are well established. However, use of periconceptional folic acid remains disappointingly low despite clear evidence of benefit – typically less than one-third of women actually take periconceptional folic acid supplements. This chapter considers the many factors influencing the prevalence of periconceptional folic acid use – demographic, socioeconomic, lifestyle, gynaecological, previous pregnancies, current pregnancies, other medical conditions and access to folic acid supplements. The importance of underlying awareness and knowledge is discussed, including the various sources of information. The role that these factors may have in shaping future strategies to promote folic acid supplementation is also considered.
Folic acid supplementation
Neural tube defect
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Neutral tube defects (NTDs) occur at an incidence of about 0.01 per cent, and in Denmark 40-50 new cases are recorded annually. Although the metabolism of folic acid increases during pregnancy, the dietary supply is marginal. Finding in recent studies suggest that folic acid supplementation as prophylactic treatment of gravidae reduces the incidence of NTDs. Folic acid prophylaxis is already being recommended as a general policy, with treatment starting before conception.
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This paper focuses on the current best-evidence-based clinical practices and controversies surrounding folic acid supplementation/fortification for the prevention of neural tube defects (NTDs) during early pregnancy. The paper also discusses the controversies surrounding the effect of folic acid on the prevention as well as the promotion of cancer. Sufficient data is available to safely conclude that folic acid reduces the risk of NTDs during pregnancy; however, a safe dosage has not yet been calculated for the rest of the population. More research is necessary to study the complete role of folic acid in human growth and development.
Folic acid supplementation
Neural tube defect
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The conclusion of a report recently published by EUROCAT is that the potential for preventing neural tube defects with periconceptional folic acid supplementation is still far from being fulfilled in Europe. A number of recommendations to increase periconceptional folate status are made. In Denmark less than 20% of pregnant women follow the official recommendations on periconceptional folic acid supplementation, making the conclusions of the EUROCAT report relevant.
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Neural tube defect
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Folic acid supplementation
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Neural tube defects represent one of a limited number of congenital conditions for which primary prevention strategies are available. Despite strong clinical evidence to support the preventive effect of supplementary folic acid given prior to conception and continued throughout the first 12 weeks of pregnancy, there is limited recent epidemiological data to support the effectiveness of national folic acid supplementation programs. Whether folic acid fortification of staple foods will provide a more effective means of achieving further reductions in the prevalence rates for this condition remains open to question. Recent advances associating folic acid supplementation, hyperhomocysteinaemia and neural tube defects provide a new insight into the possible pathological mechanism of this and possibly other related congenital conditions.
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Neural tube defect
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Periconceptional folic acid supplementation has been shown to decrease the occurrence of neural tube defects (NTD’s). In a cross-sectional study, the knowledge attitude and practice regarding the peri-conceptional use of folic acid were assessed among the pregnant women in Benghazi, Libya. 131 women attending antenatal clinics in three main polyclinics were interviewed through three polyclinics. Seventy-three percent of the participants had heard about folic acid, and only 37% could correctly identify the effect of folic acid when used periconceptionally. 27% of the pregnant women did not take folic acid during their present pregnancy. Only 6% of the women who took folic acid were taking it consistently before pregnancy with the aim of preventing NTDs. This study shows that the interviewed pregnant women reveal high positive attitude (88%) toward retaking folic acid supplements in their next pregnancy. The overall knowledge regarding the periconceptional use of folic acid was relatively low when compared to other studies worldwide. Health education regarding the periconceptional use of folic acid among newly married couples is recommended.
Folic acid supplementation
Neural tube defect
Cross-sectional study
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Objective: To provide the latest and most promising evidence on the prevalence and determinants for folic acid supplementation in pregnant women in Japan, including differences in prevalence between interview years and determinants across regions.Materials and methods: The study participants were enrolled from 15 regional centers across Japan between January 2011 and March 2014. Information on the use of folic acid supplementation before and during pregnancy and the characteristics of the participants were collected using questionnaires, medical chart reviews, and interviews by research coordinators.Results: Data for 91,538 women who provided sufficient data on folic acid supplementation were analyzed. The prevalence of adequate users was 8.0%, which, although low, tended to improve over the 4-year recruitment period. Various kinds of sociodemographic factors, lifestyle habits, and obstetrical and medication use history were significant and independent determinants for folic acid use. Associations between adequate preconception folic acid use and its major determinants tended to be similar across regions.Conclusions: Although the prevalence of adequate folic acid use was low, it increased from 2011 to 2014. Reproductive-aged women who have determinants for inadequate folic acid use should be informed about the need for preconception folic acid supplementation to help prevent neural tube defects.
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