In recent days, a court ruling has come to light that acquitted a 20-year-old woman with a disability who has sued her mother’s doctor for lack of information before pregnancy.
In particular, the professional rider with a disability in the spine, Evie Toombes, sued her mother’s doctor, claiming that if he had given her the right advice, she would have postponed getting pregnant and her daughter would not have been born with a split back.
In the landmark case of the “unjust arrest”, Dr. Philip Mitchell was taken to court for failing to advise her mother on dietary supplements before becoming pregnant. The 20-year-old claimed that if the doctor had advised her mom, Caroline, to take folic acid to minimize the risk of spina bifida in her baby, she would have postponed conception. This in turn would mean that Evie would never have been born.
Evie has filed a “unjust arrest” lawsuit because she was “born with injuries,” Susan Rodway’s lawyer told the court.
And in an unprecedented ruling in the High Court of London, Judge Rosalind Coe upheld Evie’s case, paving the way for huge compensation. The judge found that Dr. Philip Mitchell had not told Caroline about the importance of taking folic acid supplements before becoming pregnant. And if he had told her, he would have been late in getting pregnant and instead would have had a different, perfectly healthy baby, she added.
We asked the obstetrician-gynecologist, Christos Maggio, to tell us about how important it is for a pregnant woman, or a woman who wants to get pregnant, to take folic acid.
The administration of folic acid supplement (0.4 – 0.8 mg per day) and the recommendation for consumption of foods fortified with folic acid is one of the main interventions in the context of a woman’s visit for prenatal care before conception and this is done to reduce the risk. congenital abnormalities of the neural tube and possibly other abnormalities in the fetus, the specialist initially explains.
Mr. Mantzios emphasizes that this recommendation does not only apply to women who are actively trying to conceive, but also extends to all women of reproductive age who are likely to become pregnant.
Educating women about the need to use folic acid is very important at every visit to the gynecologist or other health care provider because many women are unaware of this recommendation and learn it for the first time during their first visit to the maternity ward as part of a new pregnancy or choose not to follow it due to cost or other difficulties.
Women who do not take supplements still consume a small amount of folic acid, as it is a natural ingredient in a variety of foods and various products, mainly cereals, in many countries are fortified with it.
Folic acid (or vitamin B9) is found naturally in many foods, such as beef liver, leafy vegetables, peas and beans, avocados, eggs and milk.
Folic acid is also found in various supplements, multivitamins, prenatal vitamins or even plain. It is also added to fortify certain foods, such as flour, pasta, breads, cereals, cornflour and rice, and has been added to some estrogen-progesterone oral contraceptive pills to ensure adequate basal levels of folic acid in case of non-preterm pregnancy. inconsistent / incorrect use of contraceptives or conception immediately after discontinuation.
Despite the fortification of foods with folic acid, this does not seem to be enough. Supplement use seems necessary, and the United States Preventive Services Task Force reaffirmed in 2017, the 2009 recommendation that women of childbearing potential who are planning to become pregnant or are likely to become pregnant should take folic acid supplementation. 0.4 – 0.8 mg per day.
Research data show a 93% reduction in the chance of neural tube defects in women without a history of fetal disease, and 70% in women with a history of such a history.
Frequency and dosage
Most major national medical organizations and public health authorities recommend that all women of childbearing potential, not just those trying to conceive, take folic acid supplementation once a day. This broad recommendation is based on the large number of unplanned pregnancies (up to 50% of pregnancies in the United States are unplanned) and the fact that neural tube closure occurs very early in pregnancy, before many women realize they are pregnant (26 to 28 days after conception, ie up to six weeks of gestation).
For most women, the typical folic acid supplement (multivitamin, prenatal vitamin) is 0.4 mg, taken once a day, starting at least one month before attempting to conceive and continuing throughout pregnancy. This dose ensures adequate levels of folic acid during organogenesis, which occurs mainly in the first trimester, as well as later in pregnancy, when folic acid is required to meet the developmental needs of the fetus and the mother. All prenatal and multivitamins contain at least 0.4 mg of folic acid.
Some guidelines recommend starting folic acid supplementation at least one month before conception, while others recommend starting two to three months before conception, especially if there is a previous history of a fetus with a neural tube defect.
Women at higher risk than the general population to have a child with a neural tube defect (previous history with a descendant with a neural tube defect from both parents, previous personal history with a neural tube defect, previous individual or family history other folic acid-related abnormalities other than neural tube defects, neural tube defects in first- or second-degree relatives, type I or II diabetes, maternal intestinal absorption disorders, advanced hepatic impairment, renal impairment, hemodialysis ) are candidates for a higher (1 to 4 mg) dose of folic acid supplements. This dose should be started one to three months before conception and maintained for the first 12 weeks of pregnancy, after which the dose should be reduced to 0.4 mg.
Women should not try to achieve the required dose of folic acid by increasing the number of multivitamin preparations they consume as they may reach increased levels of consumption of other vitamins, eg vitamin A, which can become dangerous / toxic to the fetus.
Finally, measuring maternal folic acid levels before or after supplementation is generally not recommended and there are no clear risks of using folic acid, except for vitamin B12 deficiency. The above recommendations have nothing to do with the treatment of severe folic acid deficiency, folic acid is generally easily absorbed and excess is not stored in fat and excreted by the body.
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