Daily folic acid recommended for most women

Most of my patients make their first appointment to discuss pregnancy once they've become pregnant, not in the planning stages. Unfortunately, most women are unaware of some very important preconception medical recommendations.

Folic acid, or folate, is a vitamin recommended for all women of reproductive age who are sexually active.

Folic acid reduces the incidence of neural tube defects (NTDs). NTDs are deformities of the brain and spine, the most common of which is spina bifida. The neural tube is formed in the first few weeks of pregnancy, before most women realize they're pregnant. Folic acid should be taken for at least three months prior to conception, and through the first trimester.

The incidence of NTD in Canada is roughly 1/1000 births, or 400 cases each year. British Columbia has an average of 22 NTD births annually. (This does not reflect the spontaneous and induced abortions of affected fetuses.) It is estimated that at least half of these cases could have been prevented by adequate folate intake.

It is very difficult to absorb enough folate by diet alone. I have seen several cases of spina bifida in children born to well women with healthy diets in their thirties.

Women usually require 0.4 mg of folate per day. A woman with diabetes, epilepsy, or a family history of NTD may require 4.0 mg/day. Women should discuss their recommended dose with their physician.

As half of Canadian pregnancies are unplanned, women should take folate supplements even if they are using contraception.

Despite this recommendation being in effect for years, and a folic acid awareness campaign launched by Health Canada in 2002, very few of my patients are aware of it. This is one of many reasons to visit your physician before you attempt pregnancy.