Neural tube defect prevention
Folic acid taken by women of reproductive age 1–3 months pre-conception and through the first 12 weeks of pregnancy reduces the risk of open neural tube defects in the foetus (anencephaly, spina bifida) by 70%. A foundational preventive intervention recommended by all international obstetric societies.
ICD-10 Q052 drugs
Also known as: NTD prevention, Spina bifida prevention
Drugs used for this condition
- AFolic acidFirst line · Vitamins. Haemopoietic stimulantsFolic acid 400 µg daily in all women planning pregnancy and through the first 12 weeks of pregnancy is foundational neural tube defect prevention. USPSTF 2023 reaffirmed recommendation A. In women with a prior NTD pregnancy, diabetes, epilepsy, obesity, or on antiepileptics, the dose is increased to 4–5 mg daily. The Cochrane review confirmed a 70% reduction in open neural tube defects.
- BLevomefolate (L-methylfolate, 5-MTHF)Add-on therapy · Active form of vitamin B9, ready for methylation reactionsLevomefolate is used to prevent fetal neural tube defects as an alternative to classical folic acid. SEGO 2020 recommends 0.4 mg folic acid daily 1–3 months before conception and throughout the first trimester for all women planning pregnancy, with 5 mg/day in high-risk groups (prior NTD, diabetes, obesity, antiepileptics). In women with confirmed homozygous MTHFR C677T, levomefolate is a reasonable alternative, but USPSTF 2023 notes that NTD prevention efficacy is established for classical folic acid; data on 5-MTHF are limited.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit