Once weekly folic acid supplementation in Malaysian women

None listed

Neural tube defects (NTDs) are serious birth defects affecting the brain and spine. Folic acid supplementation in early pregnancy has been shown to reduce the incidence of NTDs. Currently, the World Health Organization recommends weekly iron (60 mg) and folic acid (2.8 mg) (IFA) supplementation among women and adolescents in areas where anaemia prevalence is >=20%. A weekly dose of 2.8 mg folic acid was chosen because it was seven times the daily dose known to reduce NTDs; however, evidence is lacking to confirm this is an optimal dose. We aim to conduct a three-arm randomised controlled trial to examine the effects of three different weekly doses of folic acid on red blood cell folate concentrations. We will recruit women (n=300; 18-45 y) from Kuala Lumpur, Malaysia. We will randomise women individually, to receive one of three weekly doses of folic acid (2.8, 0.4 or 0 mg) with 60 mg iron for 16 weeks (with a scheduling allowance of +2 weeks), followed by a 4-week washout period (with a scheduling allowance of +2 weeks). Fasting venous blood will be drawn at baseline, 16, and 20 weeks. We will measure plasma folate, red blood cell folate, and other markers of nutrition and inflammation, and genetic polymorphisms in folate metabolism. The primary outcome is baseline adjusted red blood cell folate at 16 weeks, analyzed with use of a generalized estimating equation (intention-to-treat). This research is expected to inform the WHO guidelines for weekly iron and folic acid supplementation, particularly on the optimal folic acid dose.