Rockenbach Marília Körbes, Rohweder Ricardo, Schuler-Faccini Lavinia, Sanseverino Maria Teresa Vieira, Kowalski Thayne Woycinck
Graduate Program in Genetics and Molecular Biology (PPGBM), Genetics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre 91501-970, Brazil.
Teratogen Information System (SIAT), Medical Genetics Service (SGM), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil.
Nutrients. 2025 Aug 26;17(17):2752. doi: 10.3390/nu17172752.
Folic acid supplementation during the periconceptional period is a well-established strategy to prevent neural tube defects (NTDs). However, emerging uncertainties surrounding optimal dosage, alternative folate forms, duration of use, and the role of genetic variability have sparked scientific and policy debates. In Brazil, these challenges are amplified by unique contextual factors, including the routine distribution of high-dose folic acid (5000 µg) through the public health system, social vulnerability, low adherence, and limited population-specific evidence for the country's highly admixed population. This narrative review critically examined the scientific evidence and public health policies surrounding folic acid supplementation, with a focus on Brazil. We examined historical developments, international recommendations, and emerging controversies, including the emerging influence of misinformation. Despite the worldwide progress in NTD prevention, both local and global challenges persist, including delayed initiation, inconsistent adherence, and uncertainty regarding alternative supplementation regimens. Addressing these demands requires the development of context-specific guidelines, alongside coordinated strategies in provider training, public education, monitoring, and research investments to ensure effective, safe, and equitable folic acid supplementation.
孕期补充叶酸是预防神经管缺陷（NTDs）的一项成熟策略。然而，围绕最佳剂量、替代叶酸形式、使用时长以及基因变异的作用等新出现的不确定性引发了科学和政策辩论。在巴西，这些挑战因独特的背景因素而加剧，包括通过公共卫生系统常规分发高剂量叶酸（5000微克）、社会脆弱性、依从性低以及针对该国高度混合人群的特定人群证据有限。本叙述性综述批判性地审视了围绕叶酸补充的科学证据和公共卫生政策，重点关注巴西。我们研究了历史发展、国际建议以及新出现的争议，包括错误信息的新影响。尽管全球在预防神经管缺陷方面取得了进展，但地方和全球挑战依然存在，包括开始补充延迟、依从性不一致以及替代补充方案的不确定性。应对这些需求需要制定因地制宜的指南，同时在提供者培训、公众教育、监测和研究投资方面采取协调一致的策略，以确保叶酸补充有效、安全且公平。
