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Health Condition

Birth Defects Prevention

  • Folic Acid

    Supplementing with folic acid before and during the early weeks of pregnancy dramatically reduces the risk of neural tube defects.

    Dose:

    At least 400 mcg daily
    Folic Acid
    ×

    Several studies and clinical trials have shown that 50% or more of NTDs can be prevented if women consume a folic acid-containing supplement before and during the early weeks of pregnancy.1,2 The United States Department of Public Health, the Centers for Disease Control and Prevention (CDC), and the March of Dimes recommend that all women who are capable of becoming pregnant supplement with 400 mcg folic acid daily. Daily supplementation prior to pregnancy is necessary because most pregnancies in the United States are unplanned3 and the protective effect of folic acid occurs in the first four weeks of fetal development,4 before most women know they are pregnant.

    For women who have had a previous NTD-affected pregnancy, the CDC recommends daily supplementation with 4,000 mcg per day of folic acid. In a preliminary study, this amount of supplemental folic acid before and during early pregnancy resulted in a 71% reduction in the recurrence rate of NTDs.5

  • Choline

    Choline appears to protect against neural tube defects when taken prior to and early in pregnancy, as it has similar biochemical effects as folic acid.

    Dose:

    500 mg choline per day
    Choline
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    In a preliminary study of California mothers, those who had higher intakes of choline during the three months prior to conception were significantly less likely to give birth to a child with an NTD, compared with women with lower choline intakes.6 The possibility that choline may protect against NTDs is plausible, as choline has similar biochemical effects as folic acid, which is known to reduce NTD risk.
  • Lecithin (Phosphatidyl Choline)

    Choline appears to protect against neural tube defects when taken prior to and early in pregnancy, as it has similar biochemical effects as folic acid.

    Dose:

    500 mg choline per day
    Lecithin (Phosphatidyl Choline)
    ×
    In a preliminary study of California mothers, those who had higher intakes of choline during the three months prior to conception were significantly less likely to give birth to a child with an NTD, compared with women with lower choline intakes.7 The possibility that choline may protect against NTDs is plausible, as choline has similar biochemical effects as folic acid, which is known to reduce NTD risk.
  • Multivitamin

    Taking a multivitamin three months prior to and three months into a pregnancy has been associated with a reduced rate of many birth defects.

    Dose:

    Follow label instructions
    Multivitamin
    ×

    Use of a multivitamin supplement during the periconceptional period (defined as from the three months prior to pregnancy to the third month of pregnancy) can contribute significantly to a healthy pregnancy. Use of a multivitamin during these crucial months of fetal development has been associated with a reduced occurrence of many birth defects. In a preliminary study, periconceptional use of a multivitamin was associated with a lowered risk of heart defects in the offspring.8 This association was not evident when use of the multivitamin began after the first month of pregnancy. The authors of this study concluded that approximately one in four major heart defects could be prevented by periconceptional multivitamin use. In another preliminary study, periconceptional use of a multivitamin was associated with a 43% reduction in the risk of having an infant with a severe heart defect.9

    In a double-blind trial, women given a multivitamin containing folic acid starting at least one month before becoming pregnant to at least the second month of pregnancy were much less likely to have a child with a birth defect than were women given a trace mineral supplement.10 The greatest reduction in risk was seen in the occurrence of urinary tract defects and heart defects. A preliminary study found that periconceptional use of a multivitamin reduced the risk for urinary tract defects and limb defects.11 When multivitamin use was begun after the periconceptional period, there was a reduction in risk noted for cleft palate and again for urinary tract defects.

    Childhood brain tumor rates may also be reduced by a mother’s intake of a multivitamin while pregnant. In a preliminary study, use of a multivitamin by women for at least two-thirds of their pregnancy was associated with a decreased risk of brain tumor in the offspring compared to women who took a multivitamin for less than two-thirds of the pregnancy.12 The greatest reduction of brain tumor risk (about 50%) was among children whose mothers took a multivitamin throughout the entire pregnancy.

  • Zinc

    Many doctors recommend a zinc-containing multivitamin to all women of childbearing age who may become pregnant for its potential role in preventing neural tube defects.

    Dose:

    15 mg daily
    Zinc
    ×
    In a preliminary study, women with the highest total dietary zinc intake before pregnancy (including zinc from both food and supplements) had a 35% decreased risk of having an NTD-affected pregnancy.13 However, another preliminary study found no association between blood levels of zinc in pregnant women and the incidence of NTDs.14 Zinc supplementation (15 mg per day) is considered safe for pregnant women. Given its safety and potential role in preventing NTDs, a zinc-containing multivitamin is recommended by many doctors to all women of childbearing age who may become pregnant.
What Are Star Ratings
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

References

1. MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131-7.

2. Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-5.

3. Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol. 1994;170:1485-9.

4. Moore KL. Formulation of the trilaminar embryo. In: The Developing Human. Philadelphia, PA: WB Saunders Co., 1988:55-64.

5. Centers for Disease Control and Prevention. Use of folic acid for prevention of spina bifida and other neural tube defects: 1983-1991. MMWR 1991;40:513-6.

6. Shaw GM, Carmichael SL, Yang W, et al. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol 2004;160:102-9.

7. Shaw GM, Carmichael SL, Yang W, et al. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol 2004;160:102-9.

8. Botto LD, Mulinare J, Erickson JD. Occurrence of congenital heart defects in relation to maternal mulitivitamin use. Am J Epidemiol 2000;151:878-84.

9. Botto LD, Khoury MJ, Mulinare J, Erickson JD. Periconceptional multivitamin use and the occurrence of conotruncal heart defects: results from a population-based, case-control study. Pediatrics 1996;98:911-7.

10. Czeizel AE. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet 1996;62:179-83.

11. Werler MM, Hayes C, Louik C, et al. Multivitamin supplementation and risk of birth defects. Am J Epidemiol 1999;150:675-82.

12. Preston-Martin S, Pogoda JM, Mueller BA, et al. Prenatal vitamin supplementation and risk of childhood brain tumors. Int J Cancer Suppl 1998;11:17-22.

13. Velie EM, Block G, Shaw GM, et al. Maternal supplemental and dietary zinc intake and the occurrence of neural tube defects in California. Am J Epidemiol 1999;150:605-16.

14. Hambidge M, Hackshaw A, Wald N. Neural tube defects and serum zinc. Br J Obstet Gynaecol 1993;100:746-9.

15. Cnattingius S, Signorello LB, Anneren G, et al. Caffeine intake and the risk of first trimester spontaneous abortion. N Engl J Med 2000;343:1839-45.

16. Clarren SK, Smith DW. The fetal alcohol syndrome. N Engl J Med 1978;298:1063-7.

17. Jones KL. Fetal alcohol syndrome. Pediatr Rev 1986;8:122-6.

18. Streissguth AP, Aase JM, Clarren SK, et al. Fetal alcohol syndrome in adolescents and adults. JAMA 1991;265:1961-7.

19. Stratton K, Howe C, Battaglia F, eds. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment. Washington, DC: National Academy Press; 1996:4-21.

20. Gold S, Sherry L. Hyperactivity, learning disabilities and alcohol. J Learn Disabil 1984;17:3-6.

21. Mills JL, Granbard BI, Harley EE, et al. Maternal alcohol consumption and birth weight: how much drinking in pregnancy is safe? JAMA 1984;252:1875-9.

22. Kaminski M. Maternal alcohol consumption and its relation to the outcome of pregnancy and child development at 18 months. Int J Epidemiol 1992;21(suppl 1):S79-81.

23. Rudolph L, Forest CS. Female reproductive toxicology. In: LaDou J, ed. Occupational Medicine. Norwalk, CT: Appleton & Lange, 1990:275-87.

24. Paul M, ed. Occupational and Environmental Reproductive Hazards. A Guide for Clinicians. Baltimore, MD: Williams & Wilkins, 1993:xviii.

25. Lalande NM, Hetu R, Lambert J. Is occupational noise exposure during pregnancy a risk factor of damage to the auditory system of the fetus? Am J Ind Med 1986;10:427-35.

26. Shaw GM, Todoroff K, Finnell RH, Lammer EJ. Spina bifida phenotypes in infants or fetuses of obese mothers. Teratology 2000;61:376-81.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2019.