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تعداد آیتم قابل مشاهده باقیمانده : -5 مورد

Examples of clinical guidelines for folic acid supplementation

Examples of clinical guidelines for folic acid supplementation
Indication for supplementation Dose (daily) Start (minimum) Initial duration* Recommended by
High risk
Open NTD any first degree relative of either parent or a personal history of open NTD in either parent[1,2] 4 mg 3 months PTC 12 weeks SOGC, ACOG
Moderate risk
Personal or family history of folate-sensitive congenital anomaly other than NTD[2] 1 mg 3 months PTC 12 weeks SOGC
Family history of NTD (first- or second-degree relative)[2] 1 mg 3 months PTC 12 weeks SOGC
Type 1 or 2diabetes[2-4] 1 mg 3 months PTC 12 weeks SOGC
0.4 mg 1 month PTC 12 weeks ADA, ACOG
Maternal gastrointestinal malabsorption (eg, gastric bypass surgery, inflammatory bowel disease, active celiac disease)[2] 1 mg 3 months PTC 12 weeks SOGC
Medical conditions associated with increased risk (eg, advanced liver disease, dialysis, alcohol use disorder, use of antiepileptic or other folate-inhibiting medications, obesity)[2] 1 mg 3 months PTC 12 weeks SOGC
Low risk
Pregnancy or potential for pregnancy[1,5,6] 0.4 mg At least 1 month PTC 12 weeks ACOG, CDC
0.4 to 0.8 mg 1 month PTC First 2 to 3 months of pregnancy USPSTF
Clinical guidelines vary regarding the dose of folic acid supplementation in females taking antiseizure medications. Refer to UpToDate content on management of epilepsy during preconception, pregnancy, and the postpartum period.

ACOG: American College of Obstetricians and Gynecologists; ADA: American Diabetes Association; CDC: Centers for Disease Control and Prevention; NTD: neural tube defect; PTC: prior to conception; SOGC: Society of Obstetricians and Gynaecologists of Canada; USPSTF: United States Preventive Services Task Force.

* After 12 weeks, supplementation via a routine prenatal vitamin is recommended through the remainder of pregnancy and lactation to fulfill ongoing maternal and fetoplacental folate requirements.

References:

  1. American College of Obstetricians and Gynecologists Committee on Practice Bulletins. Practice bulletin no. 187: Neural tube defects. Obstet Gynecol 2017; 130:e279.
  2. Wilson RD, O'Connor DL. Guideline no. 427: Folic acid and multivitamin supplementation for prevention of folic acid-sensitive congenital anomalies. J Obstet Gynaecol Can 2022; 44:707.
  3. American College of Obstetricians and Gynecologists Committee on Practice Bulletins. ACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus. Obstet Gynecol 2018; 132:e228.
  4. American Diabetes Association. Management of diabetes in pregnancy: Standards of medical care in diabetes—2018. Diabetes Care 2018;41:S137.
  5. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Folic acid supplementation for the prevention of neural tube defects: US Preventive Services Task Force recommendation statement. JAMA 2017; 317:183.
  6. Folic acid: Facts for clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/folic-acid/hcp/clinical-overview/ (Accessed August 15, 2024).
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