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Risk of Neural Tube Defects Based on Red Blood Cell Folate among Women in the Dominican Republic

Evidence shows a strong causal association between low maternal folic acid (FA) in take and increased risk for neural tube defects (NTD). Folic acid intake of at least 400μg per day is recommended for women of reproductive age (WRA) capable of becoming pregnant to reduce the prevalence of NTDs. Red blood cell (RBC) folate ≤151 ng/mL (≤340 nmol/L) is commonly used to define FA deficiency and is a metabolic indicator based on the relationship between RBC folate and homo cysteine concentrations. In a new WHO guideline, RBC folate concentration ≤400 ng/mL (≤906 nmol/L) define FA insufficiency among WRA at the population level based on the functional indicator of risk of NTD‐affected pregnancies. We examined RBC folate results from a national survey conducted in the Dominican Republic in 2009 among 443 non‐pregnant women 15–49 yrs using these different cut‐offs. FA deficiency was 7.0% when using the metabolic indicator cut off and FA insufficiency was 75.8% when using the functional indicator cut‐off. The risk for NTD‐affected pregnancies in the Dominican Republic was high based on the prevalence of FA insufficiency in this population. Countries may find a much larger percentage of WRA have FA insufficiency and are at risk of NTD‐affected pregnancies than previously considered based on the metabolic indicator, making it important to examine RBC folate data using the new functional indicator cut‐off.