The Effectiveness of Folate-Fortified Oral Contraceptives in Maintaining Optimal Folate Levels to Protect Against Neural Tube Defects: A Systematic Review.
OBJECTIVE
To conduct a systematic review evaluating the effectiveness of a folate-fortified oral contraceptive preparation in increasing blood folate concentrations to levels providing optimal protection against neural tube defects (> 906 nmol/L).


METHODS
We searched Medline, EMBASE, Web of Science, and the Cochrane Library for human studies published from inception to June 2013 that evaluated oral contraceptive use and folate status. Case-control studies, cohort studies, and clinical trials were included. Efficacy and bioequivalence data were evaluated from included studies.


RESULTS
Overall, efficacy and bioequivalence data for the folate-fortified oral contraceptive show that it is at least as effective as folic acid alone in raising blood folate concentrations, and that the concomitant administration of folate with the oral contraceptive component does not affect its absorption or kinetics.


CONCLUSIONS
A folate-fortified oral contraceptive preparation provides an option for women to maintain blood folate levels, especially those who may be planning a family after the cessation of oral contraceptive therapy.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON.
Mahvash
M
Shere
The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON; Department of Pharmacology and Toxicology, University of Toronto, Toronto ON.
Priya
P
Bapat
The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON.
Cheri
C
Nickel
Department of Pharmacology and Toxicology, University of Toronto, Toronto ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ON.
Bhushan
B
Kapur
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON; Department of Pharmacology and Toxicology, University of Toronto, Toronto ON.
Gideon
G
Koren
D000736:Androstenes; D003276:Contraceptives, Oral; D004997:Ethinyl Estradiol; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D009436:Neural Tube Defects / Q000517:prevention & control*; D011247:Pregnancy
D000736:Androstenes; D003276:Contraceptives, Oral; C534342:drospirenone and ethinyl estradiol combination; D004997:Ethinyl Estradiol; D005492:Folic Acid
family planning; folate; oral contraceptive; pregnancy; prenatals