Preconcepton Health - Folic Acid for the Primary Prevention of Neural Tube Defects

Table of Contents

Introduction

Background Information

• Congenital anomalies. What are we talking about?
• Could I see people affected by congenital anomalies and NTDs in my practice?
  In my community?
• What are the implications of being born with an NTD?

Primary Prevention of NTDs with Folic Acid

• What is the evidence that NTDs are preventable?
• How does folic acid work?
• To be effective in preventing NTDs, when should folic acid be taken?
• What type of supplement can I recommend to women who could become pregnant?
• What about food fortification? Why should women still take supplements containing folic acid?
• Many of my patients have healthy diets. Do they need to take supplements?
• Some of my patients may not be able to afford supplements. What can I do?

Etiology of NTDs and Pregnancies at Increased Risk for NTDs

• What causes NTDs and who is at increased risk?
• How much folic acid is recommended for women whose pregnancy is at increased risk for NTDs?
• My patient took folic acid as recommended and still had a child with an NTD. What advice should she be given? What about her next pregnancy?
• My patient had one child with an NTD, was taking high dose folic acid, and had another child with an NTD - what next?

Prenatal Screening, Diagnosis and Intervention

• What are the possibilities for prenatal diagnosis of NTDs?
• What about management of a pregnancy and delivery of a fetus diagnosed prenatally with an NTD or other congenital anomaly?
• What is being done to monitor outcomes of prenatal screening and diagnosis programs?

Safety Issues

• How safe is folic acid?
• How do I identify patients who may have vitamin B12 deficiency?

Anything Else I Should Know?

Table

References

Appendix

Acknowledgements