Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO

Abstract

Objective: To summarize the recommendations on folate intake and folic acid supplementation and fortification in the periconceptional period, aimed at prevention of neural tube defects (NTD), provided by official health organizations in different countries worldwide and WHO.

Design: Information on recommendations for folate and folic acid intake in the periconceptional period was gathered from the websites of official national health organizations of several countries worldwide and from the WHO website.

Setting: WHO, selected developed countries and emerging economies, totalling thirty-six countries worldwide (some European, BRICS, G8, Asian Tiger/Asian Dragon and Australia).

Results: Recommendations differ between countries, although the majority (69·4 %) recommend a healthy diet plus a folic acid supplement of 400 µg/d from preconception (4-12 weeks) until the end of the first trimester of pregnancy (8-12 weeks). The same recommendation is issued by the WHO. Dosages for women at high risk of NTD are up to 4-5 mg/d (for 41·7 % of studied countries). The recommended intake for folate is in the range of 300-400 µg/d for women of childbearing age and 500-600 µg/d for pregnant women in different countries and WHO. Five countries emphasize the importance of a healthy diet rendering supplementation needless. By contrast, five others advise a healthy diet and supplementation plus mandatory fortification. Only one mentions the importance of ensuring an adequate folate status and refers to checking with a health-care provider on the need for supplements.

Conclusions: Different recommendations regarding folate and folic acid, seeking NTD prevention, are available worldwide; however, most countries and WHO focus on a healthy diet and folic acid supplementation of 400 µg/d periconceptionally.

Keywords: Folate; Folic acid; Neural tube defects; Official health organizations’ recommendations; Periconceptional period.

Fig. 1

World map showing the thirty-six countries in which recommendations for folate and folic acid intake in the periconceptional period were analysed (●, country with official validation; ∗, country without official validation)

Fig. 2

Recommended folate intake and recommended folic acid supplementation for prevention of NTD during the periconceptional period (NTD, neural tube defects; D-A-CH, Deutschland–Austria–Confoederatio Helvetica (reference values for nutrient intake by the German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research and Swiss Society for Nutrition); NNR, Nordic Nutrition Recommendations (by Denmark, Finland, Iceland, Norway and Sweden); IOM, Institute of Medicine, Dietary Reference Intakes; WHO, Vitamin and Mineral Requirements in Human Nutrition ^{( 42 )}). Definition of periconceptional period adapted from Steegers-Theunissen et al.^{( 44 )}