Giving Folic Acid with IPTp-SP

The World Health Organization (WHO) recommends a dose of 60 mg of iron and 0.4 mg of folic acid during pregnancy, ideally in one combined supplement to make it easier for women to take IFA. Taking one pill instead of two improves women’s compliance with iron-folic acid (IFA) supplements. A dose of 0.4 mg of folic acid is sufficient to prevent anemia and meet increased requirements for folic acid during pregnancy. It also is a safe level of folic acid for administration with intermittent preventive treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP). Because the malaria parasite needs folic acid to survive and thrive, a dose of 5 mg or more of folic acid reduces the effectiveness of SP as an antimalarial. The Roll Back Malaria Partnership Malaria in Pregnancy Working Group issued a Consensus Statement recommending a dose of folic acid of less than 5 mg per day during pregnancy. A new brief,  developed by the Maternal and Child Survival Program (MCSP), the Centers for Disease Control, and the President’s Malaria Initiative (PMI), explains the importance of both IPTp-SP and IFA supplementation during pregnancy and why the dose of folic acid can and should be 0.4 mg per day, particularly when given in malaria endemic areas. Next steps for nutritionists:

  • Work with malaria control program staff in country to ensure women are receiving the combined dose of iron folic acid with 60 mg of iron and 0.4 mg of folic acid.
  • Reduce stores of the 5 mg dose of folic acid.
  • Scale-up IPTp-SP and IFA supplementation to ensure that at least 80 percent of pregnant women in sub-Saharan Africa.
  • Monitor the coverage and impact of the package of interventions to reduce anemia including IPTp, IFA, and deworming.

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