What is the rationale behind the new combined oral contraceptive (COC) that adds folate to the estrogen and progestin (Beyaz)? Assuming that the folate is added to prevent neural tube defects, how is this beneficial in a woman attempting to avoid pregnancy with the use of a COC? — Elizabeth Rash, PhD, ARNP, FNP-C, Orlando, Fla.

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According to the manufacturer, folate was added to “lower the risk of having rare neural tube defects in a pregnancy occurring during Beyaz use or shortly after stopping.” A more cynical assessment would assume that the manufacturer reformulated the pill to continue to profit from a branded product that invariably costs the consumer far more than the generic.

In any event, it is clear that folic acid is essential at the time of conception, so a woman receiving this supplement in her birth control is assured of adequate levels of this vitamin in the rare case she gets pregnant on the pill or if she were to conceive shortly after discontinuing the pill. — Mary Newberry, CNM, MSN (161-5)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a question, submit it here.