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Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prevention of Neural Tube Defects

Obstet Gynecol; ePub 2017 Dec; ACOG, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued management recommendations about neural tube defects (NTDs) for pregnancies completed by a fetal NTD, with primary prevention of NTDs possible with folic acid. Among the recommendations:

Level A:

  • All women planning a pregnancy or capable of becoming pregnant should take 400 micrograms of folic acid supplementation daily. Supplementation should begin at least 1 month before pregnancy and continue through the first 12 weeks of pregnancy.
  • Women at high risk of NTDs should take 4 mg (4,000 micrograms) of folic acid daily. The daily supplement should be initiated 3 months before pregnancy and continued until 12 weeks of gestational age.

Level B:

  • Ultrasonography in the second trimester is recommended for all pregnant women; the optimal time for a single ultrasound examination is 18–22 weeks, allowing for confirmation of gestational age and screening for anomalies, including NTDs.
  • Although it is possible to detect some NTDs in the first trimester, the detection rate appears to be much lower than with second-trimester ultrasonography. Therefore, a normal first-trimester ultrasound examination should not be substituted for a screening ultrasonography at 18–22 weeks.
  • A patient with a fetus with an NTD should be offered the management options of pregnancy termination, expectant management with neonatal surgical repair, and in utero fetal repair for appropriate candidates.
  • For the patient who elects to continue the pregnancy, genetic evaluation by amniocentesis for chromosomal microarray should be recommended.

Citation:

Neural tube defects. Practice Bulletin No. 187. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e279–90.

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