Folic acid, still recommended for women who may conceive?

December 17, 2013 7:56 PM

In light of the editorial on vitamins published today in the Annals of Internal Medicine that advises Americans stop taking vitamin supplements, should women who are trying to conceive still take folic acid?

Unfortunately reading the entire article requires a subscription to the site and none of the news articles I've read today cover it. Clearly I should ask my doctor for medical advice, but I was so surprised to not see it listed as an outlier like vitamin D (which it sounded like the jury was still out on). Women of childbearing age have got to make us a large segment of the population, so I'm a bit confused why this wasn't addressed. Has anyone seen a recent write-up on this?

posted by tigeri to Health & Fitness (11 answers total)

Folic acid for pregnant women isn't a supplement, that's literally a prescription dispensed from a pharmacy.

Lord knows I've written enough of those. And yeah, you should probably stick to the ones that are (in theory) tested by the FDA rather than the ones whole foods sells.
posted by hobo gitano de queretaro at 8:03 PM on December 17, 2013 [2 favorites]

This study was for cancer prevention and repeat heart attacks. Here's a link to an AP wire story.
posted by PaulaSchultz at 8:20 PM on December 17, 2013

Best answer: What I read about that editorial was that it derived its conclusions exclusively from three large trials of men which showed multivitamins to have no effect on cancer and heart disease. There was nothing in it to contradict the long known conclusions about folic acid and neural tube defects.
posted by feets at 8:23 PM on December 17, 2013 [14 favorites]

What feets said. The study you're talking about has zero to do with folic acid supplementation as a means of avoiding neural tube defects. That data hasn't changed.
posted by fingersandtoes at 8:27 PM on December 17, 2013

The editorial even hedges its bets on applying its recommendations to people with micronutrient deficiencies, which is what you're guarding against by taking folic acid.
posted by jason_steakums at 8:30 PM on December 17, 2013

Folic acid has been shown to reduce the chances of having a baby with Spina Bifida by 70%. This new study doesn't override that evidence, but the media has a way of condensing headlines to an oversimplified level.
posted by cecic at 8:32 PM on December 17, 2013 [2 favorites]

Best answer: I am a doctor. The editorial does not apply to perinatal folate, which are absolutely recommended. In fact, they remain a Grade A recommendation from the US Preventative Services Task Force. An editorial doesn't resolve the question of other potential benefits from vitamins. It's just an editorial, and an editorial that is both somewhat inflammatory and fails to reference the one major study¹ that did suggest a potential benefit from multivitamins. This strikes me as problematic. Just my two cents, neither strongly in favor or opposed to multivitamins.
posted by drpynchon at 10:25 PM on December 17, 2013 [12 favorites]

I'm pregnant, so my OB's advice is current.

Prenatal vitamins are not necessary, but a folic acid supplement is. 800mcg a day, ideally starting three months before you conceive.
posted by lydhre at 2:09 AM on December 18, 2013

YES. Folic acid is absolutely linked with avoiding neural tube defects, which are devastating.
posted by St. Peepsburg at 8:23 AM on December 18, 2013

I believe the media coverage of that particular study to be grossly irresponsible. Even in the study itself, the authors hedge that multivitamin supplements have no effect on mortality -- when it comes to cancer and heart disease. Nothing else was measured. What's more the sample size was not only small, it was skewed toward the people who would be least likely to rack of some sort of nutrient deficit: doctors themselves. The sample was made up of doctors. Doctors are significantly more responsible and informed of health decisions than everyone else, they did after all, have to get through medical school.

Plus, doctors are naturally incentivized to care about mortality risk, but what about quality of life? They care about that too, surely, but that's much less binary. If you're deficient in x y and z, it might not kill you, but what if it just causes you to have annoying dry skin?

Multivitamins cost about $20 a year to take, vs say, statins, which were recommended for pretty much every man over a certain age based on a flawed calculator recently. Statins require much more money not to mention regular checkups and maintenance by a medical professional, and yet we are told that it's vitamins that are a waste of money? Something is seriously going on with medicine in this country and it does not lead itself to an easy non-cynical explanation.
posted by Feel the beat of the rhythm of the night at 8:24 AM on December 18, 2013 [4 favorites]

As was noted, this study didn't even consider women, much less pregnant or soon-to-be-pregnant women, so folic acid wasn't on the table - nor is it disputed (though I don't know if there have been studies related to the efficacy other micronutrients in the prenatal multivitamins that are marketed, which is where most pregnant women get their 800mg of folic acid).

Funny coincidence about this study and this question! My father, who is a pediatrician with a specialty in clinical genetics (which means he does a lot of consultation, publishing and education on this subject and takes care of babies and kids with, among other conditions, neural tube defects), was actually a participant in this study. They mailed him huge blister packs of vitamins (well, sugar pills - turns out they told him later he was in the control group) for all those years, and...drum roll...he did actually get cancer (caught very early, he is six years cancer free). And I'm currently pregnant (and taking prenatal vitamins with 800 mcg of folic acid, which I think would be all he would say is necessary (maybe iron).
posted by Pax at 12:27 PM on December 18, 2013