(PO15-50-22) The Amount of Folic Acid in Weekly Iron-Folic Acid Supplements Should Be Increased From 0.4 to 2,8 mg to Reduce Neural Tube Defects (NTD)

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Presenting Author(s)

Homero Martinez, MD, PhD
– Senior Technical Advisor, Nutrition International, Ottawa, Ontario, Canada

Co-Author(s)

KS

Kaitlyn L. Samson, MSc
– The University of British Columbia, Vancouver, British Columbia, Canada
SL

Su Peng Loh, PhD
– Universiti Putra Malaysia, Serdang, Selangor, Malaysia
SL

Siew Siew Lee, PhD
– Universiti Putra Malaysia
DS

Dian C. Sulistyoningrum, MSc
– South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
GK

Geok Lin Khor, Khor, PhD
– Universiti Putra Malaysia
MZ

Mohd Shariff Zalilah, Professor
– Universiti Putra Malaysia, Serdang, Selangor, Malaysia
II

Irmi Zarina Ismai, MD
– Universiti Putra Malaysia
LY

Lisa N Yelland, PhD
– South Australian Health and Medical Research Centre, Adelaide, South Australia, Australia
SL

Shalem Leemaqz, PhD
– South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
MM

Maria Makrides, PhD
– Theme Leader, South Australian Health and Medical Research Institute & School of Medicine, The University of Adela, Adelaide, South Australia, Australia
JH

Jennifer A. Hutcheon, PhD
– Obstetrics and Gynaecology
MR

Marion L. Roche, PhD
– Senior Technical Advisor, Adolescent and Women's Health and Nutrition, Nutrition International, Ottawa, Ontario, Canada
CK

Crystal D. Karakochuk, PhD, RD
– Assistant Professor, University of British Columbia, Vancouver, British Columbia, Canada
TG

Tim J. Green, PhD
– Principal Nutritionist, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia

Disclosure(s):

Homero Martinez, MD, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: Weekly iron–folic acid (IFA) supplements are recommended for all menstruating women in countries where anaemia prevalence is >20%. Anaemia caused by folate deficiency is low worldwide, and the need to include folic acid is in question. Including folic acid might reduce the risk of a neural tube defect (NTD) should a woman become pregnant. Most weekly supplements contain 0.4 mg folic acid; however, WHO recommends 2.8 mg because it is seven times the daily dose effective in reducing NTDs. There is a reluctance to switch to supplements containing 2.8 mg of folic acid because of a lack of evidence that this dose would prevent NTDs. Our aim was to investigate the effect of two doses of folic acid, compared with placebo, on red blood cell (RBC) folate, a biomarker of NTD risk.

Methods: We conducted a three-arm double-blind efficacy trial in Malaysia. Non-pregnant women (n=331) were randomized to receive 60 mg iron and either 0, 0.4, or 2.8 mg folic acid once weekly for 16 weeks.

Results: At 16 weeks, women receiving 0.4 mg and 2.8 mg folic acid per week had a higher mean RBC folate than those receiving 0 mg (mean difference (95% CI) 84 (54 to 113) and 355 (316 to 394) nmol/L, respectively). Women receiving 2.8 mg folic acid had a mean RBC folate 271 (234 to 309) nmol/L greater mean RBC folate than those receiving 0.4 mg. Moreover, women in the 2.8 mg group were seven times (RR 7.3, 95% CI 3.9 to 13.7) more likely to achieve an RBC folate >748 nmol/L, a concentration associated with a low risk of NTD, compared with the 0.4 mg group.

Conclusions: IFA supplements containing 2.8 mg folic acid increases RBC folate more than those containing 0.4 mg. Increased availability and access to the 2.8 mg formulation is needed.

Funding Sources: Nutrition International (Ottawa, Ontario)