According to the Australian Drug Evaluation Committee (1999), folate is considered to be safe to take in both pregnancy and lactation. Retrospective analysis of a trial of folate in pregnancy in the 1960s has suggested a possible increase in all-cause mortality and breast cancer in pregnant women taking 5 mg/day folate; however, this finding could be due to a number of factors unrelated to folate (Bland 2005, Charles et al 2004). The only context requiring special consideration is those pregnant women taking anticonvulsant medication (see Significant Interactions).
PRACTICE POINTS/PATIENT COUNSELLING
• Folate is involved in a number of important biochemical pathways required for health and wellbeing, in particular development and cell growth.
• Folate supplements are often given to correct deficiencies or prevent deficiency in people at risk, such as those with malabsorption syndromes (e.g. coeliac disease and Crohn's disease), long-term use of certain medications such as phenytoin, sulfasalazine, cimetidine, antacids and the OCP, in congenital malabsorption states and blind loop syndrome, chronic alcoholism, the institutionalised elderly, pregnant and lactating women and HIV infection.
• It is considered to be the most important supplement to be taken by women in the weeks leading up to conception and during the first 12 weeks of pregnancy, in order to significantly reduce the risk of NTD in newborns. Food fortification is not considered sufficient.
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• Other uses for folic acid supplements include reducing homocysteine levels (often in combination with vitamins B12 and B6), reducing primary cardiovascular disease riskand cancer risk in general, periodontal disease (as a topical application), depression and vitiligo, but only in patients who exhibit a deficiency.
ANSWERS TO PATIENTS' FREQUENTLY ASKED QUESTIONS
What will this supplement do for me?
Folic acid is essential for health and wellbeing. Supplements have a critical role in preventing NTD in newborns and may also reduce the risk of primary cardiovascular disease, improve brain function in Alzheimer's dementia and non-Alzheimer's dementia and depression. It can also reduce the toxic effects of some medicines and may reduce the risk of developing some forms of cancer. When will it start to work? This depends on the indication. Are there any safety issues?
The major concern with high doses of folate is that it may mask an underlying vitamin B12 deficiency and allow it to progress unnoticed, which means that a vitamin B12 deficiency should be excluded. It also interacts with some drugs in both a potentially harmful and beneficial way.
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