Folic Acid
You are probably familiar with recommending folic acid (FA) supplementation. Please do this for all your female patients of child bearing age. Talk to them at health maintenance exams (HMEs), preconception visits, negative pregnancy tests.
FA supplementation reduces the risk of spina bifida, anencephaly, and other neural tube defects (NTDs) by >50%. Neural tube defects and other FA-linked defects (facial clefts, conotruncal heart defects) occur 26-29 days after conception.
Ideally, FA supplementation should start >3months prior to conception. Unfortunately, less than 1/3 of US women take FA regularly.
Folic acid requirements at least double during pregnancy. It is essential for purine, pyrimidine synthesis, DNA/RNA. OCP's reduce folic acid absorption in gut. Supplement at least 400mcg. Also recommend dietary sources: lentils, asparagus, spinach, oranges.
Additional resources
Folic acid:
