Check your folate status before pregnancy.

Background. An increased intake of folates during periconceptional period can prevent 40-70% of neural tube defects (NTD) and perhaps other birth defects, yet in many countries the use of folic acid and compliance to recommendations (where these exist) is less than optimal. Objective. Suggest a strategy that helps individual women to obtain optimal folate levels before conception. Methods. Literature review on the relation between folate levels and NTD risk, on the effect of folic acid supplements on increasing the blood folate concentrations and folate status in women of childbearing age in various countries. Findings. Empiric evidence suggests that maternal folate levels are inversely correlated with NTD risks (Daly et al., 1995). Red blood cells folate concentrations of 906 nmol/L or greater are associated with the lowest NTD risk . This threshold is considered the “optimal concentrations before conception” by several experts. The corresponding serum folate concentration, the most important for the folate transport to the embryo during development of the neural tube and the other organs, can be estimated around 40 nmol/L. Comments. We propose, according to Tam et al. (2009), that before planning pregnancy, all women evaluate their folate levels. This blood test performed before conception could increase the fraction of women with adequate folate intake, because many women will realize to be below the optimal folate levels, thus improving compliance to recommendations. Women could then choose to do one or more of the following: (a) increase the intake of folate rich foods, (b) eat folic acid fortified foods or (c) use supplements containing folic acid. When the folate status is low and the conception could occur in a very near future (1-2 months) women could also choose to start with an high dose (4,000μg/day) for the first month, as suggested by studies on effects of folate supplementation, and then continue with the standard 400 μg /day up to the end of the third month of pregnancy. Moreover, folate status evaluation and the consequent optimal levels achievement eliminates any worry about folate biodisponibility problems due to environmental or genetic factors