Am I A High Risk Patient?

EnBrace HR is the ONLY Prenatal Vitamin That Meets the Folic Acid Recommendation for “High-Risk” NTD Patients (4mg) From: ACOG, The American Academy of Pediatrics, March of Dimes, CDC, US Dept. of Health, AHRQ, American Society for Clinical Nutrition, American College of Medical Genetics, Medical Research Vitamin Study and Joint Society of OB and GYN of Canada.

This Questionnaire Will Help You and Your Physician Determine Your Need For Folate

Answering YES to 2 or more of the un-starred questions or YES to one of the starred questions indicates a need for additional folate.

If you prefer a downloadable .pdf of this form to take to your provider please click here

Practitioner Questionnaire Reference

History of Frequent or Recurrent Miscarriages:

An association between frequent idiopathic miscarriages and folate metabolism dysfunction, particularly as related to genetic SNPs MTHFR (C677T and A1298C) has been noted in numerous studies. 

History of neural tube defects, midline defects, Down Syndrome or congenital heart defects:

Supplements containing folic acid when consumed prior to conception reduces the risk of spina bifida and other neural tube defects by an estimated 80% or more. Neural tube defects, which also include anencephaly, are severe and often lethal conditions that annually affect at least 300,000 newborns worldwide.

    • Botto L, et al. International retrospective cohort study of neural tube defects in relation to folic acid recommendations: are the recommendations working? BMJ. 2005;330:571.http://www.bmj.com/content/330/7491/571.long

    • Brandalize AP, Bandinelli E, dos Santos PA, Roisenberg I, Schuler-Faccini L. Evaluation of C677T and A1298C polymorphisms of the MTHFR gene as maternal risk factors for Down syndrome and congenital heart defects. Am J Med Genet A. 2009 Oct;149A(10):2080-7. http://www.ncbi.nlm.nih.gov/pubmed/19725133

Pre-pregnancy overweight or obesity:

Being overweight or obese prior to conception were significantly associated with numerous negative outcomes including birth defects-notably neural tube defects and congenital heart defects.

Hispanic and Mexican Descent:

Studies of geographical and ethnic variations of the C677T MTHFR SNP have found similar results in that this SNP is more frequent in Hispanic populations.  One study reported 57% of Mexicans tested had either the heterozygous or homozygous C677T variant.  For those living in the US of Hispanic descent, this number was still high at 41%.   Being of Hispanic or Mexican ethnicity or descent may lead to greater risk of MTHFR mutation thus increasing potential complications with pregnancy if not appropriately supported throughout fetal development.

  • Wilken B, et al. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas world wide.  J Med Genet. 2003;40:619-625.

  • Peng F, Labelle LA, Rainey BJ, Tsongalis GJ.  Single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene are common in US Caucasian and Hispanic American populations.  Int J Mol Med. 2001 Nov;8(5):509-11.

Type 1 Diabetes:

It is recommended that women in intermediate to high risk categories for neural tube defects, including women diagnosed with insulin dependent diabetes (Type 1) should take high dose folic acid supplementation as recommended by their healthcare provider.

Women who have recently been on or are currently taking medications known to reduce levels of folate.  These include, but are not limited to:  NSAIDs, diuretics (ex: Triamterene), methotrexate, antacids, anti-epileptics (ex: Lamictil, Carbamezapine), methotrexate, and some oral contraceptives:

A low level of folate during pregnancy is a known risk factor for negative outcomes including neural tube defects, midline defects, and other congenital abnormalities.  Low folate during early pregnancy is also associated with lower placental weight and birth weight.

  • University of Maryland Medical Center. Possible Interactions with: Vitamin B9 (Folic Acid) http://umm.edu/health/medical/altmed/supplement-interaction/possible-interactions-with-vitamin-b9-folic-acid

  • Morrell, M. Folic Acid and Epilepsy.  Epilepsy Curr. 2002 Mar; 2(2): 31–34. 2002 Mar; 2(2): 31–34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC320966/

  • Baggott, JE, Morgan SL, Ha T, Vaughn WH, Hine RJ.  Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs.  Biochem J. 1992 Feb 15; 282(Pt 1): 197–202.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130907/ Shea B, Swinden MV, Tanjong Ghogomu E, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA, Tugwell P.  Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.  Cochrane Database Syst Rev. 2013 May 31;5:CD000951. http://www.ncbi.nlm.nih.gov/pubmed/23728635

  • Mountifield JA.  Effects of Oral Contraceptive Usage on B12 and Folate Levels.  Can Fam Physician. 1985 Aug; 31: 1523–1526. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2327375/

Depression:

Numerous studies and publications have shown an association between genetic variation in folate metabolism and depression due to alteration of neurotransmitter synthesis.  One of the most common genetically based reasons for folate metabolism variations includes the MTHFR single nucleotide polymorphism (SNP) which is associated with a reduction in the bioavailability of folate and folate metabolites technically mimicking a low dietary folate intake.  As is well known, a low dietary folate has been linked to increased risk for adverse outcomes related to pregnancy.  There is evidence that consumption of specific nutrients such as B vitamins including folate can both alter neurotransmitter synthesis and absorption in pregnant women with depression thus improving health of the mother during pregnancy while also providing adequate folate to support optimal development of growing fetus.