USPSTF reaffirms benefit of folic acid supplementation

In an update of its 2009 statement on folic acid supplementation in women of childbearing age, the US Preventive Services Task Force (USPSTF) has reaffirmed the value of the vitamin for prevention of neural tube defects (NTDs). Published in JAMA, the new report recommends that all women who are planning or capable of pregnancy take a daily supplement containing 0.4 mg to 0.8 mg of folic acid.

This review of the evidence included 1 randomized clinical trial, 2 cohort studies, 8 case-control studies, and 2 publications from the 2009 analysis and looked at evidence of the effectiveness of folic acid supplementation in at least 41,802 participants. Results were not pooled because of study heterogeneity and differences in food fortification over time. The review did not include evidence on folic acid supplementation in women with a history of pregnancy affected by NTDs or other high-risk factors or on fortification, counseling to increase dietary intake of folic acid or naturally occurring food folate, or screening for NTDs.

Recommended: Recurrent pregnancy loss

As was the case 8 years ago, the USPSTF found that the net benefit of folic acid supplementation is substantial and that the harms to the mother or infant of taking the vitamin at typical doses are no greater than small.  No substantial new evidence was identified of either the benefits or harms of folic acid that would have led to a change in the group’s previous recommendation.

NEXT: Final advice from FDA, EPA on fish consumption

Final advice from FDA, EPA on fish consumption

Seven types of fish should be avoided by women who are pregnant or planning to become pregnant or breastfeeding, and by young children, according to final advice just issued by the US Food and Drug Administration (FDA) and Environmental Protection Agency (EPA). The guidance is aimed at reducing intake of mercury while promoting a minimum level of fish consumption during pregnancy and early childhood.

According to FDA and EPA, the fish to avoid are tilefish from the Gulf of Mexico, shark, swordfish, orange rough, bigeye tuna, marlin, and king mackerel because they contain high levels of mercury. The agencies recommend that women who are pregnant consume 2 to 3 servings of lower-mercury fish per week or 8 to 12 oz, which is consistent with the 2015-2020 Dietary Guidelines for Americans. Consumers who eat fish caught recreationally should base consumption on local or state advisories, if any. In the absence of advisories, FDA and EPA recommend eating just 1 fish meal a week from local waters and avoiding other fish that week.

To help consumers understand which fish to eat, the agencies have created a chart that sorts 62 types of fish into “best choices,” “good choices” and “fish to avoid.” Nearly 90% of fish consumed in the United States are in the “best choices” category, according to the FDA. An analysis by the agency shows that 50% of women eat fewer than 2 oz of fish a week, which is far less than recommended.

Next: Does low-level arsenic exposure affect fetal growth?

The final advice on fish consumption follows draft advice issued in 2014 by FDA and EPA and takes into account more than 220 comments received from academia, industry, nongovernmental organizations and consumer and external peer review of the information and method used to categorize fish.