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  • Dr. Emma Galloway MD CCFP

Three new risk categories: Folic acid for pregnant patients

One of the great things about teaching at The Review Course is having sharp residents and practice-eligible physicians who are up to date and ask us several questions about the latest guidelines - thank you!

Case in point: did you know that within the last year, the SOGC released a new guideline on pre-conception folic acid supplementation?

Until recently, I, like the rest of my practice group, had still been recommending 5mg of folic acid to people I considered to be in high risk groups: patients with diabetes or obesity, patients on anti-folate medications, and those with a family history of neural tube defects.

There is now new official guidance on this and I have changed the way I manage my pre-conception patients.

So what has changed? There is actually now a MODERATE RISK stratification; it’s not quite as simple as high versus low risk.

HIGH RISK patients need 4.0 mg of folic acid from 12 weeks preconception up to 12 weeks of pregnancy. This group includes women or male partners with a personal history of neural tube defect, or a previously affected pregnancy.

MODERATE RISK patients need 1.0 mg of folic acid from 12 weeks preconception up to 12 weeks of pregnancy. This group includes most women I used to traditionally treat as high risk: women with a personal or family history of NTD or folate-sensitive congenital anomalies, women on anti-folate medications, women with pre-existing diabetes, and women with GI malabsorptive conditions.

LOW RISK patients need 0.4 mg of folic acid 8-12 weeks preconception through to 4-6 weeks postpartum.

Once 12 weeks of pregnancy is achieved, all high and moderate risk women should step down to 0.4 to 1.0mg of folic acid up until 4-6 weeks postpartum.

This is a great counselling point to consider in any SAMP or SOO dealing with pre-conception counselling: would you be able to answer, “how much folic acid should I be recommending to this patient?”

New guidelines are released all the time, and you're expected to stay up to date when preparing for the exam. This is why this year at The Review Course we covered several important brand-new guideline updates in the areas of asthma, hypertension, lipids, COPD, and cancer screening, to name a few - all important to know for the exam.

We're also working hard on updating our summer course with the many recent guideline changes that have already happened in 2016.

What guidelines should I be studying? What if guidelines change right before the exam?

This is another common question we receive from people preparing for the CCFP exam. Check out the CFPC's exam FAQs for the official answer to this question (it's listed under “How do I know which guideline to study?”)

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