Prevention of NTD Occurrence

For the prevention of occurrence of NTDs, the US Public Health Service recommends that all women capable of becoming pregnant consume 0.4 mg of folic acid per day and that total folate consumption should not be more than 1.0 mg per day to avoid the possible risks of high intakes. The UK Expert Advisory Group recommends that women should take an extra 0.4 mg of folic acid daily from when they begin trying to conceive until week 12 of pregnancy. If a woman who has not been taking this additional amount of folic acid suspects that she may have just started a pregnancy, she should begin taking extra folic acid immediately and continue until week 12 of pregnancy. The US Public Health Service and the UK Expert Advisory Group have outlined three possible ways of achieving an extra intake of folate/folic acid: eating more folate-rich foods, eating foods fortified with folic acid, and taking folic acid as a medicinal or food supplement. It is recommended that women should use whatever source or combination of sources they prefer to ensure that they obtain the necessary extra folic acid. The effectiveness of these approaches in achieving the recommended increased population intake of folate/folic acid was considered under Prevention. As already noted, it is very difficult to achieve a total daily intake of 0.6 mg folate/folic acid from only foods naturally rich in folate. The only practical ways of obtaining the recommended extra 0.4 mg folic acid daily is by consuming folic acid supplements or fortified foods, and this should be emphasized when advising women. In countries in which there is mandatory food fortification, it is important that women are advised to continue taking supplements because fortification is designed to deliver considerably less than the recommended extra 0.4 mg daily intake of folic acid. When taking supplements, the folic acid dose should be obtained from pills containing only folic acid rather than from multivitamin preparations because of the risk of taking harmful levels of vitamins A and D in early pregnancy.

See also: Bioavailability. Cobalamins. Folic Acid. Food Fortification: Developed Countries; Developing Countries. Fruits and Vegetables. Homocysteine. Nutrient-Gene Interactions: Health Implications. Obesity: Definition, Etiology and Assessment; Complications. Older People: Nutrition-Related Problems. Socio-economic Status. Supplementation: Role of Micronutrient Supplementation.

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