The effect of once weekly folic acid supplementation on red blood cell folate concentrations in women to determine the potential to prevent neural tube defects
Bibliographic record
Abstract
In populations where the prevalence of anemia is >20% in women of reproductive age, the World Health Organization (WHO) recommends weekly supplementation with 60 mg iron and 2.8 mg folic acid as an anemia prevention strategy. Folic acid was included in this weekly supplement not only for anemia prevention, but also to reduce the risk of neural tube defects (NTD) should a woman become pregnant. The dose of folic acid is equivalent to seven times the daily dose of folic acid shown to reduce the risk of NTDs in controlled trials (0.4 mg x 7 days = 2.8 mg). However, the majority of currently-used weekly supplements contain 0.4 mg of folic acid (the daily recommended dose in pregnancy). There is a lack of evidence to support if a weekly 2.8 mg dose of folic acid is more effective at raising red blood cell (RBC) folate concentrations to a level associated with a reduced risk of NTD (>748 nmol/L) than the current practice of weekly 0.4 mg folic acid. In this three-arm randomized controlled trial, we randomized n=331 non-pregnant Malaysian women (18-45 y) to receive 60 mg iron and either 2.8, 0.4, or 0 mg folic acid. RBC and plasma folate were measured at baseline, 16 weeks, and 4 weeks after the discontinuation of the intervention. Following 16 weeks of intervention, the primary outcome of mean RBC folate in the 2.8 mg folic acid per week group was significantly higher than the 0.4 mg and 0 mg groups [mean difference (95% CI) 271 (234, 309) and 355 (316, 394) nmol/L, respectively (P<0.0001)]. Mean plasma folate in the 2.8 mg group was also higher than the 0.4 mg and 0 mg groups [mean difference (95% CI) 14.9 (12.0, 17.8) and 19.6 (16.9, 22.4) nmol/L, respectively (P<0.0001)]. At 20 weeks, mean plasma and RBC folate were still significantly higher in the 2.8 mg group than the 0.4 mg and 0 mg groups (P<0.0001). This trial provides evidence to justify the use of the WHO recommended dose of 2.8 mg folic acid in weekly iron folic acid supplements.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".