Folic acid in pregnancy: high dose supplements are also recommended after bariatric surgery

Dwyer and colleagues discuss current guidelines for high dose folic acid supplementation in pregnancy.1 High dose supplementation with 5 mg folate daily is strongly recommended in patients with a history of a previous pregnancy affected by neural tube defect. Although the evidence is less compelling, it is also widely advised in those with diabetes or obesity and those taking antiepileptic or folate antagonist medications.1High dose folate supplementation is also advisable in patients undertaking pregnancy after bariatric surgery. Women of reproductive age (18-45 years) comprise half of all patients who undergo bariatric surgery in the United Kingdom and the United States.23 A systematic review with meta-analysis of women with obesity and infertility found that three fifths conceived spontaneously after bariatric surgery.4 Thus, many women with obesity start or complete their families after bariatric surgery.5 It is recommended that they avoid pregnancy in the first 1-2 years after surgery, while undergoing rapid…
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