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Putting the spotlight on folic acid supplementation in pregnancy

Future Science Group (FSG) has announced the publication of a new article in Future Science OA, reviewing national and international guidelines for folic acid supplementation, and analyzing its potential risks and benefits in terms of maternal and fetal outcomes.

Owing to the beneficial effect of folic acid in preventing neural tube defects, most international guidelines recommend folic acid as a preconception supplement. What’s more, evidence has suggested that folic acid can have an effect on other pregnancy outcomes, such as pregnancies complicated by seizure disorders, preeclampsia, anemia, fetal growth restriction and autism. However, these associations remain controversial and, while the USA has recommended mandatory fortification in some foods, other countries have not followed suit – perhaps owing to potential adverse effects. The new review, “Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks”, aimed to synthesize current findings to aid understanding and encourage further research in this area.

Beginning with neural tube defects, Hind N Moussa and colleagues (The University of Texas Health Science Center at Houston, TX, USA) go on to discuss national and international dosage recommendations, and suggested timings for supplementation. They then discuss controversies concerning women with epilepsy; preeclampsia, fetal growth deficiency and autism risk reduction; and treatment of maternal folic acid-deficiency anemia. Finally, they turn the focus on potential adverse effects – while many are subtle, research is still largely inconclusive as to whether there is a relationship between folic acid and asthma/allergy, malignancy and twinning.

Considering the future, the authors hope that within the next decade we will gain a greater understanding of folic acid mechanisms, and that we might be moving towards a more personalized therapy approach instead of universal supplementation.

“With the different recommendations available for folic acid supplementation, and the controversies in terms of its risks and benefits, it is clear that more research is needed to clarify the best timing and dosage,” commented Francesca Lake, Managing Editor. “This review provides an intriguing overview of where we stand thus far, and we hope it will stimulate further research in this arena.”

Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks. Hind N Moussa, Susan Hosseini Nasab, Ziad A Haidar, Sean C Blackwell & Baha M Sibai. Future Science OA. DOI:10.4155/fsoa-2015-0015. Published online April 21, 2016.