Preventing Neural Tube Defects: WHO Releases New Red Blood Cell Folate Concentration Guidelines

In the effort to prevent neural tube defects (NTD), the World Health Organization (WHO) has released guidelines for optimal red blood cell (RBC) folate concentrations in women of reproductive age, based on the best currently available evidence. In parallel, a study currently published online in Birth Defects Research Part A examined the RBC folate concentrations of a national sample of U.S. women of reproductive age.  They found that more than ¾ of U.S. women were above the recommended WHO cutoff for RBC folate and were at reduced risk of an NTD-affected pregnancy. Women who took a folic-acid containing dietary supplement in addition to consuming folic-acid fortified foods were the most likely to have optimal RBC folate levels. However, current smokers, and non-Hispanic Blacks as well as Hispanic women were less likely to have optimal RBC folate concentrations.

Folate is naturally found in foods, such as leafy vegetables, and is vital for normal cell growth. However, obtaining sufficient amounts in the daily diet is often challenging. Folic acid is a synthetic compound found in supplements as well as fortified foods such as grains and ready-to-eat cereals. Health care providers, based on recommendations of the U.S. Public Health Service, recommend that women of reproductive age make sure they are taking a daily supplement containing 400 mcg of folic acid in addition to eating a healthy diet.

Both the new WHO guidelines and the RBC folate concentration study were reviewed last month in the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The authors concluded that food fortification has had a major impact on reduction in NTD-affected pregnancies. However, these new data suggest that about 22% of U.S. women still have suboptimal RBC folate concentrations. Educational programs and other interventions specifically aimed at populations at risk for insufficient RBC folate could be developed to reduce NTD rates even further.

In 2014, the Teratology Society passed a resolution recommending global folic acid fortification to reduce the occurrence of neural tube defects world-wide. To learn more, read the Society's Resolution on Folic Acid Fortification.

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