Primary Prevention of Neural Tube Defects: Not Only Preconception Folic Acid Supplementation

Neural tube defects (NTDs) are birth anomalies resulting from the embryonic neural tube's failure to fuse near the 28th day after conception. Several studies have demonstrated that periconception Folic Acid (FA) supplementation decreases the risk of NTDs by about 70 %. As a result, is recommended to consume 0,4 mg folic acid per day during the periconception period to reduce the risk of first occurrence NTDs. But several maternal conditions, increasing the risk of congenital NTDs, need a preconception evaluation and an appropriate intervention. It's well known that certain medications (such as antiepileptics and other anti-folate drugs) can to increase the risk of NTDs, as well as alterations in maternal folate and homocysteine metabolism. An augmented risk has been also documented in maternal diabetes and obesity, probably due to a sustained state of hyperglycemia and/or hyperinsulinemia. In addition, some studies have suggested that periconception maternal smoking can increase the risk of NTDs in offspring. Women suffering from malabsorption syndrome also represent a high-risk population, such as patient affected by NTDs or with previous pregnancies with NTDs. Some studies have demonstrated that maternal occupational exposure to organic compounds during early pregnancy can also represent an important risk factor. In conclusion, primary prevention of NTDs not only includes preconception FA supplementation but requires an adequate multidisciplinary risk assessment