Фолиевая кислота и дефекты нервной трубки

[alan]

Уважаемый Юрий вадимович!

Как Вы считаете, необходимо ли и нужно ли применение витаминов, содержащих фолиевую кислоту женщинам, планирующим беременность и в первом триместре беременности с целью профилактики развития дефектов нервной трубки у плода.

Best regards, Ирина

[гоша11]

Уважаемая Ирина!



Пока дожидаетесь ответа, позвольте ознакомить Вас с недавними рекомендациями канадских гинекологов:



J Obstet Gynaecol Can. 2003 Nov;25(11):959-73.



The use of folic acid for the prevention of neural tube defects and other congenital anomalies.



Wilson RD, Davies G, Desilets V, Reid GJ, Summers A, Wyatt P, Young D; Genetics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.



OBJECTIVE: To provide information regarding the use of folic acid for the prevention of neural tube defects (NTDs) and other congenital anomalies, in order that physicians, midwives, nurses, and other health-care workers can assist in the education of women in the preconception phase of their health care. OPTION: Folic acid supplementation is problematic, since 50% of pregnancies are unplanned and the health status of women may not be optimal. OUTCOMES: Folic acid supplementation has been proven to decrease or minimize specific birth defects. EVIDENCE: A systematic review of the literature, including review and peer-reviewed articles, government publications, the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) Policy Statement of March 1993, and statements from the American College of Obstetrics and Gynecology, was used to develop a new clinical practice guideline for the SOGC. VALUES: Peer-review process within the committee structure. BENEFITS, HARMS, AND COSTS: The benefit is reduced lethal and severe morbidity birth defects and the harm is minimal. The personal cost is of vitamin supplementation on a daily basis and eating a healthy diet. RECOMMENDATIONS: 1. Women in the reproductive age group should be advised about the benefits of folic acid supplementation during wellness visits (birth control renewal, Pap testing, yearly examination), especially if pregnancy is contemplated. (III-A) 2. Women should be advised to maintain a healthy nutritional diet, as recommended in Canada's Food Guide to Healthy Eating (good or excellent sources of folic acid: broccoli, spinach, peas, Brussels sprouts, corn, beans, lentils, oranges). (III-A) 3. Women who could become pregnant should be advised to take a multivitamin containing 0.4 mg to 1.0 mg of folic acid daily. (II-1A) 4. Women taking a multivitamin with folic acid supplement should be advised not to take more than 1 daily dose of vitamin supplement, as indicated on the product label. (II-2A) 5. Women in intermediate- to high-risk categories for NTDs (NTD-affected previous pregnancy, family history, insulin-dependent diabetes, epilepsy treatment with valproic acid or carbamazepine) should be advised that high-dose folic acid (4.0 mg-5.0 mg daily) supplementation is recommended. This should be taken as folic acid alone, not in a multivitamin format, due to risk of excessive intake of other vitamins such as vitamin A. (I-A) 6. The choice of a 5 mg folic acid daily dose for women considering a pregnancy should be made under medical supervision after minimizing the risk of undiagnosed vitamin B12 deficiency (hypersegmentation of polymorphonuclear cells, macrocystic indices, large ovalocytes, leukopenia, thrombocytopenia, markedly elevated lactate dehydrogenase level, confirmed red blood cell folate level). (II-2A) 7. Signs or symptoms of vitamin B12 deficiency should be considered before initiating folic acid supplementation of doses greater than 1.0 mg. (III-A) 8. A three-generation pedigree on the families of both the pregnant woman and the biological father should be obtained to identify increased risk for congenital birth defects (i.e., NTD, cardiac, chromosomal, genetic). (III-A) 9. Women who become pregnant should be advised of the availability of noninvasive screening tests and invasive diagnostic tests for congenital birth defects (including NTDs): maternal serum "triple marker screen" at 15 to 20 weeks, ultrasound at 16 to 20 weeks, and amniocentesis after 15 weeks of pregnancy if a positive screening test is present. (I-A) VALIDATION: This is a revision of a previous guideline and information from other consensus reviews from medical and government publications has been used.



Аналогичные рекомендации приняты и Ам. коллегией А&Г: полный текст здесь



Obstet Gynecol. 2003 Jul;102(1):203-13.

ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 44, July 2003. (Replaces Committee Opinion Number 252, March 2001).

ACOG Committee on Practice Bulletins



http://www.greenjournal.org/cgi/reprint/102/1/203.pdf

[Крестная]

ДА, ОБЯЗАТЕЛЬНО



Если не ошибаюсь, в США и Канаде c 1992 года выпускают "продукты для женщин детородного возраста" (разные там мюсли/хлопья) с дополнительным количеством ФК ("fortifying enriched cereal-grain products with folic acid&quot. Формально, любая женщина, которая может забеременеть должна получать 400 мкг ФК/сутки

[max_cn]

Уважаемый Юрий Вадимович!

На форуме акушеров-гинекологов я порекомендовала витамины с фолиевой кислотой женщинам детородного возраста, на что мне ответили, что витамины являются лекарственными препаратами и назначать их должен врач при очном приеме и нельзя рекомендовать их использование по интернету.

С наилучшими пожеланиями, Ирина

[Filip Moris]

В отчественной (советской по сути) медицине есть очень характерная черта - делать вид что ты умнее всех и знаешь такое..... При этом чаще всего знаний у такого доктора минус.....

С уважением,

[paromenkova]

Уважаемая Ирина!



Не сочтите за придирки, но на форуме или в сети лучше рекомендовать фолиевую кислоту в конкретной дозировке (напр. 400 мкг или 1 мг), а не "витамины с фолиевой кислотой": в большинстве поливитаминных препаратов содержится традиционно рекомендуемые 200 мкг, поэтому после "заочного" консультирования возникает опасность в погоне за компенсацией дозы фолиевой перебора дозы др. витаминов, что может быть потенциально опасным.