Editing Folate (section)

===Birth defects===
Deficiency of folate in pregnant women has been implicated in [[neural tube defects]] (NTDs), with an estimate of 300,000 cases worldwide prior to the implementation in many countries of mandatory food fortification.<ref name=Berry2010>{{cite journal |vauthors=Berry RJ, Bailey L, Mulinare J, Bower C |s2cid=36706350 |title=Fortification of flour with folic acid |journal=Food Nutr Bull |volume=31 |issue=1 Suppl |pages=S22–S35 |date=2010 |pmid=20629350 |doi=10.1177/15648265100311S103 |doi-access=free }}</ref> NTDs occur early in pregnancy (first month), therefore women must have abundant folate upon conception and for this reason there is a recommendation that any woman planning to become pregnant consume a folate-containing dietary supplement before and during pregnancy.<ref>{{cite journal|vauthors=Wilson RD, Wilson RD, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Deb-Rinker P, Dodds L, Leon JA, Lowel HL, Luo W, MacFarlane A, McMillan R, Moore A, Mundle W, O'Connor D, Ray J, Van den Hof M|title=Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies|journal=Journal of Obstetrics and Gynaecology Canada|volume=37|issue=6|pages=534–52|date=June 2015|pmid=26334606|doi=10.1016/s1701-2163(15)30230-9|doi-access=free}}</ref> The [[Centers for Disease Control and Prevention|Center for Disease Control and Prevention (CDC)]] recommends a daily amount of 400 micrograms of folic acid for the prevention of NTDs.<ref>{{Cite web|title=Folic Acid|url=https://www.cdc.gov/ncbddd/folicacid/about.html#:~:text=CDC%20recommends%20that%20women%20of,of%20folate%20through%20diet%20alone.|website=CDC|date=19 April 2021|access-date=20 December 2021|archive-date=15 July 2023|archive-url=https://web.archive.org/web/20230715011206/https://www.cdc.gov/ncbddd/folicacid/about.html#:~:text=CDC%20recommends%20that%20women%20of,of%20folate%20through%20diet%20alone.|url-status=live}}</ref> Many women take this medication less than the CDC recommends, especially in cases where the pregnancy was unplanned, or in countries that lack healthcare resources and education. Some countries have implemented either mandatory or voluntary food fortification of wheat flour and other grains,<ref name="Map" /> but many others rely on public health education and one-on-one healthcare practitioner advice. A [[meta-analysis]] of global birth prevalence of [[spina bifida]] showed that when a national, mandatory program to fortify the diet with folate was compared to countries without such a fortification program, there was a 30% reduction in live births with spina bifida.<ref name="Atta2016">{{cite journal|vauthors=Atta CA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A|title=Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis|journal=American Journal of Public Health|volume=106|issue=1|pages=e24-34|date=January 2016|pmid=26562127|pmc=4695937|doi=10.2105/AJPH.2015.302902}}</ref> Some countries reported a greater than 50% reduction.<ref name="Castillo2013">{{cite journal |vauthors=Castillo-Lancellotti C, Tur JA, Uauy R |title=Impact of folic acid fortification of flour on neural tube defects: a systematic review |journal=Public Health Nutr |volume=16 |issue=5 |pages=901–911 |date=2013 |pmid=22850218 |doi=10.1017/S1368980012003576 |doi-access=free |pmc=10271422 }}</ref> The [[United States Preventive Services Task Force]] recommends folic acid as the supplement or fortification ingredient, as forms of folate other than folic acid have not been studied.<ref name=CDCFAQ/>

A meta-analysis of folate supplementation during pregnancy reported a 28% lower relative risk of newborn [[congenital heart defect]]s.<ref>{{cite journal|vauthors=Feng Y, Wang S, Chen R, Tong X, Wu Z, Mo X|title=Maternal folic acid supplementation and the risk of congenital heart defects in offspring: a meta-analysis of epidemiological observational studies|journal=Scientific Reports|volume=5|page=8506|date=February 2015|pmid=25687545|pmc=4330542|doi=10.1038/srep08506|bibcode=2015NatSR...5.8506F}}</ref> Prenatal supplementation with folic acid did not appear to reduce the risk of preterm births.<ref>{{cite journal|vauthors=Fekete K, Berti C, Trovato M, Lohner S, Dullemeijer C, Souverein OW, Cetin I, Decsi T|title=Effect of folate intake on health outcomes in pregnancy: a systematic review and meta-analysis on birth weight, placental weight and length of gestation|journal=Nutrition Journal|volume=11|page=75|date=September 2012|pmid=22992251|pmc=3499376|doi=10.1186/1475-2891-11-75|doi-access=free}}</ref><ref>{{cite journal|vauthors=Saccone G, Berghella V|title=Folic acid supplementation in pregnancy to prevent preterm birth: a systematic review and meta-analysis of randomized controlled trials|journal=European Journal of Obstetrics, Gynecology, and Reproductive Biology|volume=199|pages=76–81|date=April 2016|pmid=26901401|doi=10.1016/j.ejogrb.2016.01.042}}</ref> One [[systematic review]] indicated no effect of folic acid on mortality, growth, body composition, respiratory, or cognitive outcomes of children from birth to 9 years old.<ref>{{cite journal|vauthors=Devakumar D, Fall CH, Sachdev HS, Margetts BM, Osmond C, Wells JC, Costello A, Osrin D|title=Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis|journal=BMC Medicine|volume=14|page=90|date=June 2016|pmid=27306908|pmc=4910255|doi=10.1186/s12916-016-0633-3|doi-access=free}}</ref> There was no relation between maternal folic acid supplementation and an increased risk for childhood asthma.<ref>{{cite journal|vauthors=Crider KS, Cordero AM, Qi YP, Mulinare J, Dowling NF, Berry RJ|title=Prenatal folic acid and risk of asthma in children: a systematic review and meta-analysis|journal=The American Journal of Clinical Nutrition|volume=98|issue=5|pages=1272–81|date=November 2013|pmid=24004895|pmc=5369603|doi=10.3945/ajcn.113.065623}}</ref>