Acid Supplementation In Pregnant Women Research Articles

Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts.

Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.

Determinants of neural tube defects among women who gave birth in hospitals in Eastern Ethiopia: evidence from a matched case control study

IntroductionNeural tube defects (NTDs) are severe birth defects caused by nutritional, genetic or environmental factors. Because NTDs continue to have a significant health and economic impact on children and community at large, it is crucial to investigate potential risk factors in order to develop novel approaches to NTDs prevention. Determinants for the development of NTDs differ by country, region as well as within the country. The objective of this study was to identify the determinants of NTDs among newborns delivered in three hospitals found in eastern Ethiopia.MethodsA hospital-based matched case-control study was conducted among 138 cases and 138 control women who delivered in three teaching hospitals in Eastern Ethiopia in 2021. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Cases were mothers who delivered a neonate with any type of NTDs regardless of gestational age or fetal viability, whereas controls were mothers who delivered an apparently healthy newborn. Chi-square was used to assess the significant difference between the two groups. Conditional logistic regression model was used to generate adjusted odds ratio with its corresponding 95% confidence intervals and compare the two groups.ResultsAnencephaly (51.4%) and spinal bifida (34.1%) were the most frequently observed NTDs. None of study participants took preconception folic acid supplementation. Being a non-formal mothers (AOR = 0.34, 95% CI: 0.12–0.92, P = 0.034), rural residence, (AOR = 3.4, 95% CI: 1.18–9.78, P = 0.023), history of spontaneous abortion (AOR = 2.95, 95% CI: 1.15–7.55, P = 0.023), having severe anemia (AOR = 3.4, 95% CI: 1.17–9.87, P = 0.024), history of fever or cold (AOR = 2.75; 95% CI: 1.05–7.15, P = 0.038), and an exposure to various agro-chemicals (AOR = 3.39, 95% CI: 1.11–10.3, P = 0.032) were independent determinants of NTDs.Conclusion and RecommendationIn this study, NTDs were associated to several determinant factors in the area, including residential area, history of spontaneous abortion, severe anemia, fever/cold, antibiotic use before or during early pregnancy, and exposure to agrochemicals. Addressing the identified determinants is critical in averting the incidence of NTDs in the study area. Moreover, more research is needed to investigate women’s dietary practices as well as the practice of preconception folic acid supplementation for pregnant women in Ethiopia’s current health care system.

Iron-folic acid adherence and associated factors among pregnant women attending antenatal care at Metema District, Northwest Ethiopia.

Iron deficiency accounts for about half of anemia cases worldwide. Iron and folate supplementation can effectively control and prevent anemia during pregnancy. Despite the efforts to reduce iron deficiency anemia during pregnancy, only a few women took an iron supplement as recommended. The aim of this study is to assess adherence to iron-folic acid supplementation and associated factors. A facility-based cross-sectional study was conducted from April 1 to May 31, 2021, among pregnant women attending the antenatal care clinic at Metema district governmental health institutions. Data was collected through face-to-face interviews with an interviewer-administered questionnaire. Epi info version 7.1 and SPSS 20 were used for data entry and analysis. Binary logistic regression analysis was done to identify factors associated with iron-folic acid supplementation for pregnant women. Significant associations were determined based on the adjusted odds ratio (AOR) and 95% confidence, with a p-value < 0.05. The proportion of pregnant women adhering to iron-folic acid supplementation was 34.9% (95% CI: 31, 38.8%). Maternal educational status [AOR = 6.09, 95% CI (3.26, 11.4)], time of first antenatal consultation [AOR = 1.95, 95% CI (1.25, 3.06)], having good knowledge of iron with folic acid supplementation [AOR = 2.80, 95% CI (1.83, 4.28)], having a good understanding of anemia [AOR = 1.61, 95% CI (1.06, 2.43)], and a history of anemia during current pregnancy [AOR = 2.31, 95% CI (1.36, 3.94)] were factors affecting iron-folic acid supplementation adherence. Iron-folic acid supplementation adherence was low in the study area. Increasing maternal awareness, having good knowledge about the benefits of iron-folate supplements, and early registration to antenatal care were positive determinants of iron with folic acid adherence.

The Fish Oil to Reduce Tobacco Use iN Expectant mothers (FORTUNE) feasibility trial

Three small clinical trials have suggested that supplementation with n-3 long-chain polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid) found in fish oils may reduce nicotine cravings and at higher doses reduce cigarette consumption. Pregnant women who smoke have fewer pharmacologic options to aid them with smoking cessation. Although n-3 long-chain polyunsaturated fatty acid supplementation has been studied in pregnancy, few studies have evaluated doses of ≥4 g per day, and no previous studies have selectively enrolled pregnant women who smoke. High-dose n-3 long-chain polyunsaturated fatty acids may aid cessation but could be poorly tolerated in pregnant women who smoke because of gastrointestinal side effects. We conducted a feasibility trial to determine the tolerability of high-dose n-3 long-chain polyunsaturated fatty acid supplementation in pregnant women who smoked. We hypothesized that n-3 long-chain polyunsaturated fatty acid doses of 4.2 g a day would be well-tolerated relative to an olive oil placebo. We assessed red blood cell phospholipid membrane concentrations at baseline and end of therapy (4 weeks) and piloted outcomes for a future efficacy trial of n-3 long-chain polyunsaturated fatty acid supplementation for smoking cessation in pregnancy. We recruited 28 pregnant women between the gestational ages of 6 and 36 weeks who reported daily cigarette smoking and were motivated to quit to participate in a double-blind placebo-controlled randomized feasibility trial of 4.2 g per day of n-3 long-chain polyunsaturated fatty acid supplementation. Participants reported cigarettes per day, completed the Fagerström Test for Cigarette Dependence, and provided blood, urine, and exhaled CO samples. We used repeated-measures analysis of variance to pilot analyses of changes in cigarettes per day and Fagerström Test for Cigarette Dependence scores. At baseline, red blood cell membrane eicosapentaenoic acid concentrations were negatively correlated with cigarettes per day (r=-0.44; P=.04). By 4 weeks, circulating n-3 long-chain polyunsaturated fatty acid levels increased by 18% in the n-3 long-chain polyunsaturated fatty acid supplementation arm vs a decrease of 3% in the placebo arm. Occurrence of gastrointestinal side effects such as burping, heartburn, diarrhea, abdominal pain, or nausea did not differ statistically between study arms. At 4 weeks, participants allocated to the n-3 long-chain polyunsaturated fatty acids arm reported a median of 3 cigarettes per day (interquartile range, 1-8) vs 7 cigarettes per day (interquartile range, 1-14) in the placebo arm, which was not statistically significant (P=.99). Participants allocated to the n-3 long-chain polyunsaturated fatty acids arm had a decrease of 1 (interquartile range, 0-1) on the Fagerström Test for Cigarette Dependence score vs 0 (interquartile range, 0-0) for placebo (P=.46). High-dose n-3 long-chain polyunsaturated fatty acids may be tolerated in pregnant women who smoke; however, there was a high level of participant dropout, with more participants allocated to the fish oil arm becoming lost to follow-up. These results will inform the design of a future large-scale randomized controlled trial to test the impact of fish oil supplements on smoking cessation in pregnancy.

Folic acid supplementation in pregnant women with hepatitis B surface antigen improves infant hepatitis B surface antibody mediated by infant IL-4.

Immunoprophylaxis has not completely eliminated hepatitis B virus (HBV) infection due to hyporesponsiveness to hepatitis B vaccine (HepB). We explored the impact of folic acid supplementation (FAS) in pregnant women with positive hepatitis B surface antigen (HBsAg) on their infant hepatitis B surface antibody (anti-HBs) and the mediation effect of infant interleukin-4 (IL-4). We recruited HBsAg-positive mothers and their neonates at baseline. Maternal FAS was obtained via a questionnaire, and neonatal anti-HBs and IL-4 were detected. Follow-up was performed at 11-13 months of age of infants, when anti-HBs and IL-4 were measured. We applied univariate and multivariate analyses. A mediation effect model was performed to explore the mediating role of IL-4. A total of 399 mother-neonate pairs were enrolled and 195 mother-infant pairs were eligible for this analysis. The infant anti-HBs geometric mean concentrations in the maternal FAS group were significnatly higher than those in the no-FAS group (383·8 mIU/ml, 95 % CI: 294·2 mIU/ml to 500·7 mIU/ml v. 217·0 mIU/ml, 95 % CI: 147·0 mIU/ml to 320·4 mIU/ml, z = -3·2, P = 0·001). Infants born to women who took folic acid (FA) within the first trimester were more likely to have high anti-HBs titres (adjusted β-value = 194·1, P = 0·003). The fold change in IL-4 from neonates to infants partially mediated the beneficial influence of maternal FAS on infant anti-HBs (24·7 % mediation effect) after adjusting for confounding factors. FAS during the first trimester to HBsAg-positive mothers could facilitate higher anti-HBs levels in infants aged 11-13 months partly by upregulating IL-4 in infants.

An evaluation of adherence to folic acid supplementation in pregnant women during early gestation for the prevention of neural tube defects.

Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status. Prospective observational study. Women ≤18 weeks' gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of ≥30·0 kg/m2 and ≥27·5 kg/m2 when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher's exact test for independence analysed differences in variables. A P value of <0·05 was considered significant. A total of 328 women participated over a duration of 6 weeks. Mean gestational age was 12·4 ± 1·4 weeks and mean BMI 26·7 kg/m2 ± 5·2 kg/m2. 23·8 % (n 78) were classified as obese. 96·5 % (n 315) were taking folic acid and 95·7 % (n 314) supplemented daily. 30·2 % (n 99) commenced supplementation 12 weeks prior to conception. Overall, 57·9 % (n 190) of women met folic acid supplementation dose requirements. 89·1 % (n 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (P =< 0·001). Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.

Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial.

Iron deficiency in pregnancy is a major public health problem that causes maternal complications. The objective of this randomized, controlled trial was to examine the bioavailability, efficacy, and safety of oral ferrous bisglycinate plus folinic acid supplementation in pregnant women with iron deficiency. Subjects (12–16 weeks of gestation, n = 120) were randomly allocated to receive oral iron as ferrous bisglycinate (equiv. iron 24 mg) in supplement form with folinic acid and multivitamins (test group, n = 60) or as ferrous fumarate (equiv. iron 66 mg iron, control group, n = 60) after breakfast daily. Iron absorption was assessed by measuring fasted serum iron levels at 1 and 2 h immediately after supplementation. Hematological biomarkers and iron status were assessed before intervention, and at 3 and 6 months. Side effects were monitored throughout the intervention. A significant increase in serum iron was seen in both groups (p < 0.001) during the bioavailability assessment; however, the test group increases were comparatively higher than the control values at each timepoint (p < 0.001). Similarly, both test and control groups demonstrated a statistically significant increases in hemoglobin (Hb) (p < 0.001), erythrocytes (p < 0.001), reticulocytes (p < 0.001), mean corpuscular volume (MCV) (p < 0.001), mean corpuscular hemoglobin (MCH) (p < 0.001), mean corpuscular hemoglobin concentration (MCHC) (p < 0.001), % transferrin saturation (p < 0.001), and ferritin (p < 0.001) at 3 and 6 months after supplementation. However, in all cases, the test group increases were numerically larger than the control group increases at each timepoint. The test intervention was also associated with significantly fewer reports of nausea, abdominal pain, bloating, constipation, or metallic taste (p < 0.001). In conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental iron dosage.

Liposomal ferric pyrophosphate and ascorbic acid supplementation in pregnant women with iron deficiency anaemia: haematochemical, obstetric, neonatal and psychological outcomes in a prospective observational study

This study aimed to determine the effects of liposomal iron pyrophosphate/ascorbic acid on clinical and psychological outcomes in pregnant women. Women at the 11th–13th weeks of gestation with iron deficiency anaemia assuming Sideremil™ from April 2018 to May 2019 were recruited. Haematochemical, obstetric, neonatal and psychological outcomes were investigated at the enrolment, 21–23 weeks of gestation, 30–32 weeks of gestation and after 6 weeks from childbirth. Results showed significant positive effects on haemoglobin, ferritin, sideremia and transferrin levels, compared to baseline data. A significant improvement of anxiety and depression levels was also observed. Regarding the quality of life, all the domains significantly improved, especially the Physical Role domain. Our results indicate that Sideremil™ may be a valid treatment for iron deficiency anaemia in pregnant women, since it significantly improves haematological and mental health outcomes. However, further studies are needed to confirm these results.

788 Can urinary metabolite markers at 12-20 weeks’ gestation be used to predict birthweight?

To examine if urinary metabolites are predictive of birthweight. Urine samples were collected at 12-20 weeks’ from 126 women participating in the Mothers, Omega 3 & Mental Health Study, a double blind, placebo-controlled randomized controlled trial of omega-3 fatty acid supplementation for pregnant women identified at high risk for depression. Delivery birthweights were available for 112 of the participants and classified as small for gestational age (SGA, n=9), appropriate for gestational age (AGA, n=84) and large for gestational age (LGA, n=19). Urine samples underwent ion pairing reverse phase LC-MS analysis for 49 metabolites. Principle component analysis (PCA) was used to determine if there was a relationship between individual metabolites and weight classification. Means of each metabolite were calculated for each birthweight group and were statistically compared using T tests. In the SGA group, we found increased mean concentrations of urinary gluconate (P=0.046), inosine (P=0.020), and a-hydroxyisobutyrate (P=0.043) as well as decreased concentration of hypoxanthine (P=0.021) when compared with the mean urinary concentrations of these metabolites among mothers who gave birth to AGA infants. There were no significant differences between mean metabolite concentrations in the LGA and AGA groups. Our exploratory study found four early pregnancy urinary metabolites (gluconate, inosine, a-hydroxyisobutyrate, hypoxanthine) to be correlated with later SGA birthweight. Further research is warranted to evaluate whether these markers may identify women at risk of delivering SGA neonates. Earlier detection may impact pregnancy care and antenatal fetal surveillance. This may be particularly important for gravid woman at risk for developing depressive symptoms.

Fatores Associados a Suplementação de Ácido Fólico em Gestantes Atendidas em uma Maternidade Filantrópica

Folic acid is a vitamin of the B complex that has great importance for the growth and health of the fetus in closing the neural tube, in addition to preventing fetal diseases and malformations. The research aimed to verify the factors associated with folic acid supplementation in pregnant women attended at a philanthropic maternity hospital in São Luís - MA. This is a cross-sectional and analytical study, carried out from September to December 2018. A questionnaire was used containing socioeconomic, demographic, lifestyle and reproductive data. Anthropometric measurements (weight and height) were measured. Multivariate analysis was performed using the Poisson regression method. Of the 130 pregnant women, 67.6% reported folic acid supplementation. During prenatal care, 86.15% had six or more consultations. They were associated with not using folic acid supplementation during pregnancy is in the first (RP: 0.44; CI: 0.27-0.74) and in the second trimester of pregnancy (RP: 0.30; CI: 0, 15-0.61) and have completed incomplete / complete elementary school (RP: 2.28; CI: 1.01-5.11). Action planning is necessary, emphasizing the benefits of folic acid supplementation from the period before conception until the 14th gestational week.

Gestational Diabetes Mellitus and Folic Acid Supplementation in Pregnant Women: A Systematic Review

Background: Gestational diabetes mellitus (GDM) is a common pregnancy disorder screened for between the 24th and 28th weeks of gestation using oral glucose tolerance test. GDM has maternal and fetal health implications. Objective: To assess the relation between folic acid supplementation in pregnant women and the risk of developing GDM. Search Strategy: The search employed topic-based strategies designed for each database in June 2020. Databases searched were Pubmed, Cochrane Library, Embase and Lebanese American University online database. Selection Criteria: Studies eligible were those targeting the association of GDM development and folic acid supplementation, including pregnant women who have developed GDM and pregnant women who were on folic acid supplementation and developed GDM. Both interventional and observational studies were included. Data Collection and Analysis: Two reviewers extracted the data independently. A third reviewer checked the data for consistency and clarity. Data extracted included the sample characteristics, sample size and outcomes. Cohen’s κ was used to assess agreement between reviewers. All tools and processes were piloted prior to use. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data was presented in a tabulated form. Main Results: Six studies showed a proportional relation between folic acid intake and GDM, two reported a protective effect, and one cohort found no association. Conclusion: The inconsistent results made the formulation of a definitive conclusion difficult. Hence, larger studies are needed.

Role of pharmacist's counseling on folate compliance

Background: Pregnant women's compliance with a regimen of folate supplementation is an important factor in decreasing incidence of neural tube defects (NTDs). Because effective medication counseling can be used to enhance women's compliance with folate intake, pharmacists can help ensure good pregnancy outcomes by improving women's compliance through such counseling. Objectives: To determine the effect of medication counseling delivered by pharmacists on compliance among pregnant women in Tabuk, Saudi Arabia. Materials and Methods: A cross-sectional analytical study was conducted of 360 pregnant women who attended antenatal care clinics at primary health-care centers in 2018. A well-designed questionnaire was used for data collection. The data were analyzed using descriptive statistics and the Chi-squared test. Results: About half of the study participants began consuming folic acid after becoming pregnant (55.8%) and only 28.6% reported preconceptional intake. The most common reason for noncompliance was forgetfulness (64.40%). Almost two-thirds of women knew the importance of taking folate in pregnancy to prevent NTDs (64.2%). Their main sources of knowledge about folic acid were doctors (35.8%) and pharmacists (25%). A significant association was found between regular folate intake and pharmacist counseling as a source of folate information. Conclusion: Almost half of pregnant women complied with their folate supplementation regimen. However, lower preconceptional intake was observed. Participants' level of awareness of the importance of folic acid supplementation for pregnant women, though adequate, was not sufficient to ensure good pregnancy outcomes. Pharmacists were identified as a valuable source of information about folic acid, with their provision of medication counseling significantly associated with regularity of folate intake.

Comparing folic acid dosage strengths to prevent reduction in fetal size among pregnant women who smoked cigarettes: A randomized clinical trial

This randomized clinical trial examines the effect of folic acid supplementation in pregnant women who smoke tobacco on infant birth weight, infant status as small for gestational age, and fetal growth restriction.

Comparing Folic Acid Dosage Strengths to Prevent Reduction in Fetal Size Among Pregnant Women Who Smoked Cigarettes

This randomized clinical trial examines the effect of folic acid supplementation in pregnant women who smoke tobacco on infant birth weight, infant status as small for gestational age, and fetal growth restriction.

Does docosahexaenoic acid supplementation for pregnant women improve neurocognitive outcomes in children?

Does docosahexaenoic acid supplementation for pregnant women improve neurocognitive outcomes in children?

Randomized controlled trial of brain specific fatty acid supplementation in pregnant women increases brain volumes on MRI scans of their newborn infants

Docosahexaenoic acid (DHA) and arachidonic acid (ArA) are essential brain specific fatty acids (BSFA) for mammalian central nervous system development. Human brains have accelerated growth with significant increase in cerebral content of ArA and DHA during the last trimester of pregnancy and first postnatal months. This randomized double blind placebo controlled single centre trial assessed the impact of BSFA supplementation in pregnancy on newborn infants' brain volumes. Eighty six infants born to study mothers had brain magnetic resonance imaging (MRI) scans soon after birth. Total and regional brain volumes were analyzed and related to maternal supplementation group. Males born to the BSFA supplemented mothers had significantly larger total brain volumes, total gray matter, corpus callosum and cortical volumes when compared to the placebo group. This is the first study to show maternal BSFA supplementation enhances newborn infants' brain size and suggests differential sex sensitivity of fetal brains to pregnancy BSFA status.

Update on the prevalence and determinants of folic acid use in Japan evaluated with 91,538 pregnant women: the Japan Environment and Children’s Study

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.

Impact of Weekly Versus Daily Iron-folic Acid Supplementation for Pregnant Women with Anemia on Hemoglobin Levels, Clinical Symptoms and Subjective Complaints

Impact of Weekly Versus Daily Iron-folic Acid Supplementation for Pregnant Women with Anemia on Hemoglobin Levels, Clinical Symptoms and Subjective Complaints

Assessment of Folic Acid Supplementation in Pregnant Women by Estimation of Serum Levels of Tetrahydrofolic Acid, Dihydrofolate Reductase, and Homocysteine.

Background. Status of folic acid use in pregnant women of the hilly regions in North India was little known. This study was carried out to assess the folic acid use and estimate folate metabolites in pregnant women of this region. Materials and Methods. This cross-sectional study is comprised of 76 pregnant women, whose folic acid supplementation was assessed by a questionnaire and serum levels of homocysteine, tetrahydrofolic acid (THFA), and dihydrofolate reductase (DHFR) were estimated using Enzyme Linked Immunoassays. Results. The study data revealed awareness of folic acid use during pregnancy was present in 46.1% and 23.7% were taking folic acid supplements. The study depicted that there was no statistically significant difference between serum levels of THFA and DHFR in pregnant women with and without folic acid supplements (p = 0.790). Hyperhomocysteinemia was present in 15.78% of the participants. Conclusion. Less awareness about folic acid supplementation and low use of folic acid by pregnant women were observed in this region. Sufficient dietary ingestion may suffice for the escalated requirements in pregnancy, but since this cannot be ensured, hence folic acid supplementation should be made as an integral part of education and reproductive health programs for its better metabolic use, growth, and development of fetus.

Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update.

During the last decade critical new information has been published pertaining to folic acid supplementation in the prevention of neural tube defects (NTDs) and other folic acid–sensitive congenital malformations. These new data have important implications for women, their families, and health care professionals. We performed a review looking for the optimal dosage of folic acid that should be given to women of reproductive age who are planning or not avoiding conception to propose updated guidelines and thus help health care providers and patients. In addition to fortification of dietary staples with folic acid, women of reproductive age should supplement before conception with 0.4‐1.0 mg of folic acid daily as part of their multivitamins. In the United States all enriched rice is also fortified with folic acid at 0.7 mg per pound of raw rice. However, this is not the case in many countries, and it has been estimated that only 1% of industrially milled rice is fortified with folic acid. In countries where rice is the main staple (eg, China), this does not allow effective folate fortification. Whereas the incidence of NTDs is around 1/1000 in the United States, it is 3‐ to 5‐fold higher in Northern China and 3‐fold higher in India. A recent population‐based US study estimated that the reduction in NTD rates by folic acid is more modest than previously predicted. The potential of NTD prevention by folic acid is underutilized due to low adherence with folic acid supplementation, and calls for revising the policy of supplementation have been raised. We identified groups of women of reproductive age who may benefit from higher daily doses of folic acid, and this should be considered in current practice. These include women who have had previous pregnancies with NTDs, those who did not plan their pregnancy and hence did not supplement, and women with low intake or impaired adherence to daily folic acid supplementation. In addition, women with known genetic variations in the folate metabolic cycle, those exposed to medications with antifolate effects, smokers, diabetics, and the obese may benefit from higher doses of folic acid daily during the first trimester.