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Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2005 Massachusetts Medical Society. All rights reserved.

Folic acid recommendations have little effect on birth defects ▸

For more than a decade, we’ve known that folic acid supplementation in reproductive-age women can reduce the incidence of neural tube defects in infants by as much as 80%. Study results have shown that folic acid fortification of flour can be effective, but the effectiveness of recommendations alone has not been determined. These investigators examined data from birth-defect registries to determine whether public recommendations to increase folic acid intake through diet or supplements—but not through food fortification—have reduced the incidence of neural tube defects.

From 1988 through 1998, 8636 cases of anencephaly and spina bifida occurred among more than 13 million births in nine European countries and Israel (areas without mandated fortification of flour). Trends in incidence rates did not change significantly after local recommendations to increase folic acid intake were issued in eight of these countries.

Comment ▸

These findings seem to validate the U.S. and Canadian decisions to fortify flour with folic acid, which were followed by reduced incidence of neural tube defects in those countries. Additionally, practitioners are encouraged to recommend use of multivitamins that contain folic acid to all reproductive-aged women, and especially to those contemplating pregnancy. Recommendations alone are unlikely to be effective in reducing the incidence of neural tube defects.

Robert W. Rebar, MD

Published in Journal Watch May 6, 2005

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Neonatal behavioral complications from SRI exposure: fairly common, rarely serious ▸

Use of serotonin reuptake inhibitors (SRIs) during pregnancy is not associated with fetal anomalies, but concerns about behavioral signs led the Food and Drug Administration to require labels warning about potential neonatal complications from late-pregnancy exposure. Researchers …

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