Preconception Care and Folic Acid Supplementation
Folic Acid Supplementation
- The American College of Medical Genetics recommends that all women of reproductive age take a daily supplement of 400 mcg (0,4 mg) of folic acid for 2-3 months before conception and during the first trimester of pregnancy to reduce the risk of neural tube defects and other congenital anomalies 1, 2, 3
- Women with a low risk of neural tube defects should take 400 mcg (0,4 mg) of folic acid daily as part of a multivitamin for 2-3 months before conception, throughout pregnancy, and 4-6 weeks after delivery or during the entire breastfeeding period 1, 3
- Women with a high risk of neural tube defects (those with a history of pregnancy with neural tube defects, those with the condition themselves, those with first- or second-degree relatives with neural tube defects or type 1 diabetes) should take 4 mg of folic acid daily, starting 3 months before conception and until the 12th week of pregnancy 1, 3, 4
- Women with obesity (BMI > 30 kg/m²) should also take a higher dose of folic acid, 5 mg per day, until the 12th week of pregnancy 4, 5
General Nutrition and Lifestyle Recommendations
- Women should avoid consuming large fish (shark, swordfish, king mackerel) that contain high levels of mercury 4
- Women with excess weight or obesity should aim to lose weight before pregnancy to reduce the risk of complications (gestational diabetes, hypertension, macrosomia, congenital anomalies) 4
Chronic Disease Evaluation and Management
- Women with diabetes should aim to achieve optimal glycemic control before conception (target HbA1c ≤7%) to reduce the risk of congenital anomalies 4, 6
- Women with epilepsy should have their anticonvulsant therapy reviewed and possibly switched to safer alternatives during pregnancy 4
Screening and Vaccination
- Women should be screened for infectious diseases according to national recommendations 4
- Women should update their vaccination status before pregnancy 4
- Genetic counseling is recommended for women with a family history of congenital anomalies or genetic disorders 1, 3
Special Recommendations for Women After Bariatric Surgery
- Women should delay pregnancy for 12-18 months after bariatric surgery to achieve weight stabilization and normalize nutrition 5, 7
- Women should have their nutrient status closely monitored during pregnancy, including levels of iron, folic acid, vitamin B12, calcium, vitamin D, and vitamin A 7
- Women should switch from retinol to beta-carotene supplements in the first trimester of pregnancy 7