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PHS Recommendations
Occurrence Prevention:
In 1992 the U. S. Public Health Service (USPHS) published the
recommendation that all women of childbearing age consume 0.4 mg
(400 micrograms) of folic acid daily to prevent two common and
serious birth defects, spina bifida and anencephaly.
CDC estimates that 50-70%
of these birth defects could be prevented if this recommendation
were followed before and during early pregnancy.
All women between 15 and 45 years of age should consume 0.4 mg of folic
acid per day because half of U.S. pregnancies are unplanned
and because these birth defects occur very early in pregnancy (3-4 weeks
after conception), before most women know they are pregnant.
Recurrence Prevention:
All women who have already had an NTD-affected pregnancy should consume
0.4 mg (400 mcg) of folic acid every day when not planning to become
pregnant. Half of all pregnancies in the U. S. are unplanned. When these
women are planning to become pregnant, they should consult with their
health care provider about the desirability of following the August 1991
USPHS guideline. The guideline called for consumption of 4
milligrams (4000 micrograms) of folic acid daily beginning one month
before they start
trying to get pregnant and continuing through the first three months of
pregnancy. Although
it appears that a lower dose, such as 0.4 milligrams, may have as great a
beneficial effect as 4.0 milligrams, many health care providers recommend
the higher dose. This recommendation is based on data
from the most
rigorous scientific study involving women who had previous pregnancies
affected by NTDs. This dosage should be prescribed and monitored by the
health care provider. Typically, a health care provider will
prescribe one prenatal vitamin plus three 1 mg tablets of folic acid a day
to get this dosage. Keep in mind that we do not understand all the
causes of neural tube defects. We do know that 50%-70% can be
prevented by consuming sufficient amounts of folic acid.
IOM Recommendation
In 1998, the Food and Nutrition Board of the
National Academy of Sciences Institute of Medicine (IOM) recommended that
to reduce their risk for an NTD-affected pregnancy, women capable of
becoming pregnant should take 400 micrograms of synthetic folic
acid daily, from fortified foods or supplements or a combination of the
two, in addition to consuming food folate from a varied diet.
Link
to report.
Become Involved
Health care providers are important motivators of health behavior
change according to our research. You have the potential to
influence women of childbearing age to consume folic acid daily to reduce
their risk for NTD-affected pregnancies. Not only can you encourage
daily folic acid consumption in your face-to-face encounters, but you can
influence the community at large. The following are a few ideas for
spreading the word about the importance of childbearing age women
consuming folic acid daily:
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Ask
editors of medical newsletters, journals, or bulletins to print
articles about the importance of folic acid.
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Gather
a group of health care professionals in the community to be featured
on local television and radio shows.
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Convince
other health care providers to present the folic acid message to
medical staff while on grand rounds.
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Use
educational "prescription pads," and give a prescription for
folic acid to every woman of childbearing age as a reminder.
Encourage your colleagues to do the same.
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Display
posters, brochures, flyers, and articles about folic acid in your
office and building. (Order
free from CDC.)
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Provide a message about folic acid on your phone "hold line."
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Wear a folic acid button that reinforces the message.
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Encourage
your staff to ask about multivitamins and/or folic acid intake when
they take a history.
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