FOLIC ACID SUPPLEMENTATION AND COUNSELING Training GUIDELINES

1. FOLIC ACID SUPPLEMENTATION AND COUNSELING Training GUIDELINES Revised June 2006

2. Supplementation Program BEST PRACTICE • Assess for health conditions known to increase the risk of NTD-affected pregnancy. • Refer to appropriate services. • Provide individualized education. • Assess clients understanding of risk and decision to consume folic acid. • Provide educational materials. • Provide multivitamins with folic acid. • Document intervention and usage at each visit. Cabinet for Health and Family Services

3. BEST PRACTICE • Counseling sessions should be an opportunity for the client to ask “what changes do you plan to make” and for the provider to assess the client’s knowledge about the health benefits of folic acid. • Provide folic acid supplements to all women of childbearing age. • Provide supplementation to women having tubal ligation but not hysterectomy. • Provide appropriate educational materials. • Encourage clients to spread the word about folic acid. Cabinet for Health and Family Services

4. Clients Served in the Folic Acid Supplementation Program • All women of childbearing age. • Women receiving any other LHD service. • All women having a positive pregnancy test will receive a 3 month supply of prenatal vitamins through this program, (if not immediately available through another payment source) Cabinet for Health and Family Services

5. ASSESSMENT OF RISK • High Risk Factors • Previous pregnancy with NTD • Self or partner with NTD • Close relative with NTD • Women taking anti-seizure medication Valproic Acid [Depakote, Depacon] or Carbamazepine [Epitol, Tegretol] • Women with insulin dependent diabetes (IDDM) • Obese Women • Low Risk • None of the above identifiable high risk factors present Cabinet for Health and Family Services

6. Plan of Action Based on High Risk • Describe neural tube defects and prevention strategies • Individualized counseling/education with documentation in the medical record • Discuss dietary sources of folic acid • Provide educational handouts • Assess and document usage at each visit Cabinet for Health and Family Services

7. Plan of Action Based on High Risk (Cont.) • If not planning a pregnancy, provide multi-vitamins containing 0.4 mg (400 mcg) Folic Acid. If a pregnancy is planned in the future, discuss need for genetic counseling, nutrition therapy and consultation for possible prescription level of Folic Acid • If planning a pregnancy but without a previous NTD, provide the multivitamin containing 0.4mg (400 mcg) of folic acid and promptly refer the client for genetic counseling, medical nutrition therapy, and consultation with a health care provider to discuss additional folic acid supplementation Cabinet for Health and Family Services

8. Plan of Action Based on High Risk (Cont.) • If planning a pregnancy with a history of a previous NTD, • Provide a prescription for folic acid 4mg (4,000 mcg) to be taken daily 3 months prior to pregnancy. • Promptly refer the patient for genetic counseling, physician referral and medical nutrition therapy. • Assess and document usage at each monthly visit to the local health department. Cabinet for Health and Family Services

9. Plan of Action Based on Low Risk • Describe neural tube defects and prevention strategies • Individualized counseling/education with documentation in the medical record • Discuss dietary sources of folic acid • Provide multivitamin containing 0.4 mg (400 mcg) folic acid • Provide educational handouts • Assess and document usage at each visit Cabinet for Health and Family Services

10. Counseling Tips • Assess the client’s attitude to determine if the client is a contemplator VERSUS non contemplator. • Counseling should include NTD facts: • Description of neural tube defects • Incidence in Kentucky is 1 ½ times the national average. • 50% of all pregnancies are not planned • NTD occurs before a pregnancy test is positive • Dietary sources of folic acid and how to incorporate supplement into a daily routine. • Appropriate educational materials targeted to individual. Cabinet for Health and Family Services

11. Resources • Center for Disease Control and Prevention 1-800-311-3435 Brochures - “Before You Know You’re Pregnant” and “Ready Not” (English and Spanish) designed for the client. Publications Order Form http://www2.cdc.gov/nceh/folicorder/orderform.htm Additional brochures available that target pharmacists, primary care physicians and genetic counselors. General Folic Acid Information http://www.cdc.gov Cabinet for Health and Family Services

12. Resources (cont.) • Kentucky Department for Public Health Folic Acid Supplementation Program Coordinator - Department for Public Health (502) 564-2154, ext. 3784 • KY Folic Acid Partnership (KFAP) Campaign Coordinator- Barren River District HD (270)781-8039, ext. 181 web site www.kfap.org Cabinet for Health and Family Services

13. Resources (cont.) • State Pamphlet Library, Frankfort Habilitation 3755 Lawrenceburg Road Frankfort, KY 40601 • Phone (502) 227-9529 • Fax (502) 227-7191 • Gerald Sebree-Production Manager fhi_@dcr.net • Nutritional Flyer “Folic Acid” PAM-ACH 29 Cabinet for Health and Family Services

14. Resources (cont.) • March of Dimes Greater Kentucky Chapter 462 E. High Street, Ste. 100 Lexington, KY (866) 898-4088 www.marchofdimes.com • Folic Acid Resource Kit for Health Care Professionals • Promotional Material “Before You Know It” • Spina Bifida Association of Kentucky 982 Eastern Parkway Box 18 Louisville, Ky. 40217 866-340-7225 www.sbak.org • “Folic Acid Everyday” • “What Is Spina Bifida” Cabinet for Health and Family Services

15. Contact Information • University of Kentucky Genetic Clinic (859) 257-5559 • University of Louisville Genetic Clinic (502) 852-5334 Cabinet for Health and Family Services