Preconception care
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b22 (Published 12 February 2009) Cite this as: BMJ 2009;338:b22All rapid responses
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Birth defects are the leading cause of infant mortality in many
countries and need to be prevented. Folic acid-preventable spina bifida
is perhaps the most preventable birth defect, yet only 10 per cent of what
can be prevented is being prevented. The Inskip study shows that less
than half of women were taking folic acid when they became pregnant. It
remains very difficult to get even half of women to consume folic acid
regularly. This has been shown over and over again. Thus at least half
the women at the time of pregnancy will not be consuming enough folic
acid. This seems to me to add to the arguement for the government to
require that folic acid be added to flour. Only the behavior of the
regulatory agency will needs to be changed. This should be easier than
getting all women of reproductive age to consume a folic acid supplement
pill. I am surprised that Bille and Andersen did not call for folic acid
fortification of flour.
Competing interests:
Co inventor of patent to put folic acid in contraceptive pills and a consultant to Johnson and Johnson on this issue
Competing interests: No competing interests
Preconception opportunities
Bille and Anderson suggest that preconception nutrition and health
could be improved by introducing the topic in the school curriculum.
Whilst I thoroughly agree with their conclusion, this is an ambitious
target that requires a good deal of forward planning. My immediate
response to the challenge is twofold. Firstly, I give a leaflet about
preconception health (folic acid, smoking cessation etc.) to nearly every
patient I see for contraceptive advice. This is seldom inappropriate.
Secondly, I and my wife help to run twice yearly marriage preparation
classes for engaged couples. One session is devoted to sexuality and
parenthood and includes a five minute talk on preconception nutrition and
health and a handout of the leaflet already mentioned. Delays in
application of folic acid fortification of flour and bread due to a cancer
scare are unfortunate but understandable. Fortification would reduce the
reduce the incidence of spina bifida births by 300 cases every year and
reduce the incidence of other malformations and the incidence of small for
dates babies (1).
Nichols JAA, Curtis EPP, Rayman MP (2008). Survey of total folate
intake at conception and assessment of impact of fortification.
Nutritional & Environmental Medicine, 17:1, 44 — 55.
Competing interests:
None declared
Competing interests: No competing interests