In Canada, approximately 400 children each year are born with neural tube defects (spina bifida or anencephaly). Two recent, large-sample, randomized, controlled trials have demonstrated that folic acid supplementation around the time of conception substantially reduces the risk of neural tube birth defects. The Canadian Society of Obstetrics and Gynaecology and the Canadian College of Medical Genetics have, therefore, recommended that women at increased risk (eg, those with a prior pregnancy involving a fetus with a neural tube defect) take 0.8 to 5.0 mg of folic acid daily, while women at low risk take 0.4 to 0.8 mg daily. In the United States, both the Centers for Disease Control and the Food and Drug Administration have published similar recommendations.
Formation of the neural tube occurs at 16 to 28 days postconception; therefore, to be effective, folic acid supplementation should begin before conception and be continued throughout the first trimester. In this context, given that more than 50% of pregnancies are unplanned and that formation of the neural tube occurs before the majority of pregnancies are recognized, it has been suggested that fortification of a staple food (eg, cefeals) with fofic acid may be the most effective method of preventing “folic acid preventable spina bifida and anencephaly”. As yet, this strategy is not in place in Canada.
Folic acid is available either by prescription (5 mg tablets) or as an over-the-counter (otc) preparation, the latter, either singly (in doses of 0.4 to 0.8 mg) or in a multivitamin preparation (in doses of 0.4 to 1.0 mg).
The objectives of this study were to determine the availability and cost of folic acid supplements in urban pharmacies and to assess the level of pharmacists’ knowledge about current recom men da tions.