Nemzetközi ajánlások. Dr. Béres Judit
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1 Nemzetközi ajánlások Dr. Béres Judit
2 EUROCAT ajánlásai Nemzetközi célok European Surveillance of Congenital Anomalies (EUROCAT) Joint Action WP7 Folic Acid Supplementation EU tagországok folsav szuppl. helyzetfelmérése European Union Committee of Experts on Rare Disease (EUCERD) + EUROCAT nemzetközi ajánlás kidolgozása ig. Hazai célok: Nemzeti konszenzus ig Szakmai irányelv kidolgozás
3 1. Are there national recommendations about FA supplementation for the prevention of congenital anomalies in your country? Austria Yes Lithuania Yes Belgium Yes Malta Croatia Netherlands Yes Czech Republic Yes rway Yes Denmark Yes Poland Yes Estonia Portugal Yes Finland Yes Republic of Moldova Yes France Yes Slovenia Yes Germany Yes Spain Yes Hungary Yes Sweden Yes Ireland Yes Switzerland Yes Italy Yes UK Yes Latvia Yes Ukraine Yes
4 2. When recommendation was published and what type (Governmental /n Governmental) of institution/organization/association developed it? Austria n Governmental, 1988 Lithuania Governmental, 2006 Belgium n Governmental, 2009 Malta t applicable Croatia t applicable Netherlands Governmental, 1993 Czech Republic n Governmental, 2010 rway Governmental, 1998 Denmark Governmental, 1997 Poland Governmental, 1997 Estonia t applicable Portugal Governmental, 1998 (last updated 2006) Finland Governmental, 2004 Republic of Moldova Governmental, 2001 France Governmental, 2000 Slovenia n Governmental, 1998 Germany n Governmental, 1995 Spain Sweden Hungary Governmental, 1994/1996 Switzerland Ireland Governmental, 1993 Governmental, 1992 (last update, 2003) Governmental, 1996 (last update, 2001) Governmental, 1996 (last update, 2002) Italy Governmental, 2004 UK Governmental, 1992 Latvia n Governmental Ukraine Governmental, 2002 (last update, 2011)
5 3. What is the preventable conditions according current FA recommendation? Austria Information not available Lithuania t specify in the recommendation Belgium NTD & other CA Malta t applicable Croatia t applicable Netherlands Only NTD Czech Republic NTD & other CA rway Only NTD Denmark Only NTD Poland Only NTD (to be confirmed) Estonia t applicable Portugal Only NTD Finland Only NTD Republic of Moldova NTD& other CA France Only NTD Slovenia NTD & other CA Germany Only NTD Spain Only NTD (to be confirmed) Hungary NTD & other CA Sweden Only NTD Ireland Only NTD Switzerland NTD & other CA Italy NTD & other CA UK Only NTD Latvia Only NTD Ukraine NTD & other CA
6 4. What are standard and higher recommended dosage of FA (mcg/day) in the current recommendation? Austria 400/4000 Lithuania 400/t specified Belgium 400/4000 Malta t applicable Croatia t applicable Netherlands / Czech Republic 400/t specified rway 400/4000 Denmark 400/5000 Poland 400/t specified Estonia t applicable Portugal information about dosage Finland 400/4000 Republic of Moldova 800/t specified (to be confirmed) France 400/5000 Slovenia 400/4000 Germany 400/4000 Spain 400/4000 Hungary 800/3000 Sweden 400/ Ireland 400/t specified Switzerland 400/ Italy 400/ UK 400/5000 Latvia 400/800 Ukraine 400/800 (to be confirmed) (3)
7 5. What are the timing for FA assumption in the current recommendation? Austria Belgium Pre-conception Post-conception Pre-conception Post-conception months not specified 2 month before (8th week) Lithuania months after months not specified 3 months after Malta t applicable Croatia t applicable Netherlands Czech Republic 1 month before 3 months after rway Denmark months not specified 3 months after Poland Estonia t applicable Portugal Finland 1 month before 3 months after France 1 month before 2 month after (8th week) 1 month before 1 month before months not specified 2 months before 2 month after (8th week) 3 months after months not specified months not specified Republic of Moldova (to be confirmed) 3 months after Slovenia Germany 1 month before 3 months after Spain Hungary 3 months before month not specified (after the pregnancy) Sweden Ireland months not specified 3 months after Switzerland Italy 1 month before 3 months after UK 2 months before 1 month before 1 month before 1 month before 3 months before 3 months after 3 months after 3 months after 3 months after 3 months after Latvia 3 months before 3 months after Ukraine 3 months before 3 months after
8 6. Is planning pregnancy included in target population of current recommendation? Austria Belgium Yes all women wishing to become pregnant Lithuania pregnant women in first trimester of pregnancy Yes all women planning a pregnancy after stopping birth control pills Malta t applicable Croatia t applicable Netherlands Czech Republic Yes The women who could or plan to become pregnant" rway Yes all women wishing to become pregnant Yes women planning a pregnacy Denmark Yes women planning a pregnancy Poland Yes women planning a pregnacy Estonia t applicable Portugal Yes before stopping contraception Finland France Germany Hungary Ireland Italy Yes all women planning a pregnancy Yes women wishing to become pregnant Yes women wishing to start a family Republic of Moldova Slovenia Spain Pregnant women before 12 weeks of pregnancy Yes all women wishing to become pregnant Yes all women who are considering a pregnancy Yes Women planning a pregnancy Sweden Yes women who are planning a pregnancy (to be confirmed) Yes all women that plan a pregnancy or do not actively exclude the possibility Switzerland UK Yes All women of childbearing age without safe contraception Yes "When trying to conceive" or all women contemplating pregnancy Latvia Yes Women planning a pregnancy Ukraine all women of childbearing age
9 7. Are dietary advices about folate and FA in the current recommendation? Austria Lithuania Belgium Yes-natural food folates Malta t applicable Croatia t applicable Netherlands Yes-natural food folates Czech Republic (2010 Rec) Yes-natural food folates (1993 Rec) rway Yes-natural food folates Denmark Yes-natural food folates Poland Information not available Estonia t applicable Portugal Finland Yes-natural food folates Republic of Moldova France Yes-natural food folates(in 1993 Rec) Slovenia Yes-natural food folates Germany Yes-natural food folates Spain Yes-natural food folates Hungary Ireland Yes-natural food folates and fortified foods Yes-natural food folates and fortified foods Sweden Switzerland Yes-natural food folates Yes-natural food folates Italy Yes-natural food folates UK Yes-natural food folates and fortified foods Latvia Information not available Ukraine
10 8. Is there a national policies to provide FA for CA primary prevention free of charge? (i.e. women do not pay out-of-pocket for medicines) Austria Lithuania Belgium Malta Croatia Yes, currently fully reimbursement (see notes) Netherlands Czech Republic rway Denmark Poland Information not available Estonia Portugal Finland Republic of Moldova Yes Without details France Yes, currently partial reimbursement Slovenia Germany Spain Yes, currently partial reimbursement Hungary Sweden Yes, currently fully reimbursement Ireland Yes, currently fully reimbursement Switzerland Italy Yes currently fully reimbursement UK Yes, currently (see notes) Latvia Ukraine
11 9. Are/Was there specific EDUCATIONAL INITIATIVES about the importance of FA supplementation and dietary folate intake in the prevention of NTDs and other CA? Training for healthcar e professio nals Promotional initiatives for population Training for healthcare professional s Promotional initiatives for population Austria Lithuania Yes, previously Belgium Yes Yes, previously Malta Yes Croatia Yes Yes, currently Netherlands Yes Yes, currently Czech Rep. Yes, previously and currently rway Yes Yes, previously Denmark Yes Yes, currently Poland Yes Estonia Yes, currently Portugal Yes Finland Rep. of Moldova Yes Yes, in preparation France Yes Yes Slovenia Yes Yes, previously Germany Hungary Yes, previously and currently?? Spain Sweden Yes (to be confirmed) Yes, previously and currently Ireland Yes, previously Switzerland Yes Yes Italy Yes Yes, currently UK Yes Yes Yes, previously and currently Latvia Ukraine Yes Yes, previously
12 Folic Acid Mandatory Fortification The following countries have mandatory fortification of food with folic acid. Argentina Ghana Oman Australia Grenada Palestine, Occupied Territory Bahrain Guadalupe Paraguay Barbados Guatemala Puerto Rico Belize Guyana Qatar Bolivia Haiti Saudi Arabia Brazil Honduras South Africa Canada Indonesia St Vincent Chile (0,22mg/100g) Iran Sudan Colombia Iraq Turkmenistan Costa Rica Jamaica Uruguay Cote d'ivoire Jordan USA (0,14mg/100g) Cuba Kuwait Yemen Dominican Republic Ecuador El Salvador Fiji Mexico Morocco New Zealand Nicaragua
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15 Summary Spina bifida and anencephaly are common and serious birth defects. Available evidence indicates that 0.4 mg (400 ug) per day of folic acid, one of the B vitamins, will reduce the number of cases of neural tube defects (NTDs). In order to reduce the frequency of NTDs and their resulting disability, the United States Public Health Service * recommends that: All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs. Because the effects of higher intakes are not well known but include complicating the diagnosis of vitamin B((12)) deficiency, care should be taken to keep total folate consumption at less than 1 mg per day, except under the supervision of a physician. Women who have had a prior NTD-affected pregnancy are at high risk of having a subsequent affected pregnancy. When these women are planning to become pregnant, they should consult their physicians for advice.
16 CDC ajánlás 2011 előtt 2011 után Folsav Szupplementáció 0,4mg 0,8mg Folsav Dúsítás 0,34mg/100g 0,14mg/100g
17 Köszönöm a figyelmet! cím: OEFI honlapja:
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