What do 36 countries say about folate and folic acid pre-conception?

Portugese researchers looked at the recommendations of 36 different countries and found that the majority (69.4%) followed World Health Organisation (WHO) recommendations of a healthy diet plus folic acid supplementation of 400 micrograms per day (µg/d) from preconception (4–12 weeks) until the end of the first trimester of pregnancy (8–12 weeks). 

The report, published in Public Health Nutrition​, included: Australia, Austria, Belgium – Flanders, Brazil, Bulgaria, Canada, China, Denmark, Estonia, Finland, France, Germany, Hong Kong, Hungary, Iceland, Ireland, Italy, Japan, Latvia, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Russia, Singapore, Slovenia, South Africa, Spain, Sweden, Switzerland, Taiwan, the UK and the US.

“Interestingly, five countries (13.9 % - Finland, France, Sweden, Singapore and Taiwan) considered that a healthy diet containing adequate amounts of folate may be enough, with no need for supplementation,”​ wrote the researchers from the Institute of Public Health of the University of Porto, University of Porto Medical School and the Universidade Católica Portuguesa/Porto. 

Mandatory fortification was seen in Australia, Brazil, Canada, South Africa and the US – where supplementation was also recommended. 

For just over 40% of the countries, the dosage for women with a high risk of neural tube defects was up to 4–5 mg per day. 

All of the countries issued advice on healthy diet and/or folate-rich food.

Advice to expect​ 

The timings for supplementation also differed across countries. About 33% said at least four weeks before conception, as stated in the D-A-CH (Germany, Austria and Switzerland) recommendations. 

About 27% of them stated supplementation should begin when planning pregnancy or when there was a chance of becoming pregnant/capable of becoming pregnant, in line with the US’s Institute of Medicine (IOM). 

Nearly 14% mentioned at least 12 weeks before pregnancy. Two countries referred to 4–8 weeks or 8–12 weeks before conception, two advocated when contraception was stopped and one country recommended at least eight weeks before stopping contraception. 

Most said supplementation should be maintained until the end of the first trimester (12 weeks) or almost (ten or 8–12 weeks), but Canada, China and USA recommended supplementation until the end of pregnancy. ​

Some countries – Singapore and South Africa – advised women to ask a health care professional.

Source: Public Health Nutrition​

Published online ahead of print, doi:10.1017/S1368980015000555​​

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

Authors: S. Gomes, C. Lopes ​and E. Pinto