To prevent NTD recurrence in the offspring of women or men who have spina bifida or encephalo-coele, or a history of a previous child with NTD,
Such women and men should be counseled about the increased risk in subsequent pregnancies and about the protective effect of supplementation with folic acid. Women with a previously affected pregnancy should, unless contraindicated, be advised to take 4.0 mg of folic acid daily from at least 4 weeks before conception until the end of the third month of pregnancy. In countries in which a 5.0 mg rather than a 4.0 mg preparation is available, the former can be used but the lower 4.0 mg dose should be used as soon as this preparation becomes available. The 4.0 mg dose should be taken only under the supervision of a doctor because giving high doses of folic acid can complicate the diagnosis of vitamin B12 deficiency and epileptic women on antic-onvulsant therapy require individual counseling before starting folic acid.
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