Now I’m on the thread I cant
seem to stop. MM
Update of:
Periconceptional
supplementation with folate and/or multivitamins for preventing neural tube
defects.
Lumley J, Watson L, Watson M, Bower C.
Centre for the Study of Mothers' and Children's Health, La Trobe University,
251 Faraday St, Carlton, Vic, Australia, 3053. [EMAIL PROTECTED]
BACKGROUND: Neural tube defects arise during the development of the brain and
spinal cord. OBJECTIVES: The objective of this review was to assess the effects
of increased consumption of folate or multivitamins on the prevalence of neural
tube defects periconceptionally (that is before pregnancy and in the first two
months of pregnancy). SEARCH STRATEGY: We searched the Cochrane Pregnancy and
Childbirth Group trials register. Date of last search: April 2001. SELECTION
CRITERIA: Randomised and quasi-randomised trials comparing periconceptional
supplementation by multivitamins with placebo, folate with placebo, or
multivitamins with folate; different dosages of multivitamins or folate;
prepregnancy dietary advice and counselling in primary care settings to
increase the consumption of folate-rich foods, or folate-fortified foods, with
standard care; increased intensity of information provision with standard
public health dissemination. DATA COLLECTION AND ANALYSIS: Two reviewers
assessed trial quality and extracted data. MAIN RESULTS: Four trials of
supplementation involving 6425 women were included. The trials all addressed
the question of supplementation and they were of variable quality.
Periconceptional folate supplementation reduced the incidence of neural tube
defects (relative risk 0.28, 95% confidence interval 0.13 to 0.58). Folate
supplementation did not significantly increase miscarriage, ectopic pregnancy
or stillbirth, although there was a possible increase in multiple gestation. Multivitamins alone were not associated with
prevention of neural tube defects and did not produce additional preventive
effects when given with folate. One dissemination trial, a community
randomised trial, was identified involving six communities, matched in pairs,
and where 1206 women of child-bearing age were interviewed following the
dissemination intervention. This showed that the provision of printed material
increased the awareness of the folate/neural tube defects association by 4%,
(odds ratio 1.37, 95% confidence interval 1.33 to 1.42). REVIEWER'S
CONCLUSIONS: Periconceptional folate supplementation has a strong protective
effect against neural tube defects. Information about folate should be made
more widely available throughout the health and education systems. Women whose
fetuses or babies have neural tube defects should be advised of the risk of
recurrence in a subsequent pregnancy and offered continuing folate
supplementation. The benefits and risks of fortifying basic food stuffs, such
as flour, with added folate remain unresolved.
