31.08.2015

Folic acid pregnancy obesity

If you’re planning a pregnancy or you’re already pregnant, chances are your doctor told you to take a prenatal vitamin with folic acid to prevent neural tube defects like spina bifida and anencephaly.
Here, find out what experts are saying about folic acid, what they recommend women should take instead and how future guidelines may change. Faulty genes and folate Guidelines for folic acid were only put into place 22 years ago when women of childbearing age were recommended to take the synthetic form of folate, or vitamin B9.
Yet in recent years, more research has shown the benefit of taking the bioactive form of folate, known as L-5-methyltetrahydrofolate (MTHF). When it comes to folate, you can get it both from foods like leafy greens, nuts, seeds, and legumes and in its synthetic form as folic acid from prenatal vitamins, multivitamins and supplements.
Because of one or more defects in their MTHFR gene, about 50 percent of women in the U.S are unable to methylate or utilize folate as well. Instead, by taking MTHF directly, “You’re bypassing the way the gene will either make you or reduce your ability to methylate the folic acid,” Gottfried said. In women who are heterozygous—meaning they have one normal gene and one affected gene—their ability to utilize folic acid is 50 to 70 percent less than normal. Christianson recommends his patients take a supplement of 1,000 micrograms of MTHF as well as 400 to 800 micrograms of folate. MTHF is available as a prescription and over-the-counter, but it’s more expensive than folic acid, which could be a drawback for some women. In terms of pregnancy, folic acid is probably the nutrient that has the most emphasis placed on it. A research team gave rats 20 times their recommended dose of folic acid during mating, pregnancy and lactation.
Whilst it is still very important for women to take a folic acid supplement and whilst this study was only conducted on rates, it is interesting to consider whether a safe upper limit should be set in place – particularly as many supplements can contain large doses AND many foods are being fortified with folic acid. From this study, we can recognise that there is a need for a safe upper limit of folic acid to be defined.
Doctors recommend folic acid supplementation for expecting mothers looking to reduce their child’s risk for low birth weight, which can lead to various future health complications, including diabetes, high blood pressure, obesity, heart disease, and mental health conditions.


Khaled Ismail Professor of Obstetrics and Gynaecology at the University of Birmingham and his colleagues recorded the time of commencement for folic acid supplementation with 39,416 pregnancies, 25.5 percent of which started taking the B vitamin before conception. By the end of the study, the highest rate of babies born with SGA occurred with mothers who did not take folic acid at all during pregnancy. According to the Centers for Disease Control and Prevention, 400 micrograms of folic acid every day, starting at least one month before getting pregnant is the recommended dosage for expecting mothers looking to prevent major birth defects of their infant’s brain and spine. At the University of Georgia, a group of nutrition professors are investigating how obesity may affect folate metabolism during pregnancy. Bailey, who has studied folic acid, maternal health, and birth defects for more than three decades, has previously published research that shows obesity is associated with an increased risk of having a pregnancy affected by a neural tube defect. A new Centers for Disease Control and Prevention study, published in the Journal of Nutrition this month, states that though the majority of women do use folate during pregnancy, only half of pregnant women are using the supplement during the first trimester, when it matters most. Branum and co-workers investigated data about nearly 1,300 pregnant women surveyed from 1999 to 2006 in the National Health and Nutrition Examination Survey, an annual CDC survey used to evaluate health in the nation.
More than three-fourths, or about 77 percent, said they used a supplement in the previous 30 days, usually a multivitamin with folic acid and iron. When women can’t fully convert folic acid into folate, they may not be getting the most benefit from folic acid to prevent neural tube defects. Studies show this can increase the risk for colorectal cancer and chronic inflammation which can lead to heart disease, stroke, and obesity, Christianson said. In fact, according to an article in the Natural Medicines Comprehensive Database— a resource for health professionals that provides evidence-based reviews of dietary supplements and alternative therapies— there is no evidence that MTHF is any better than folic acid, even in people who have the MTHFR gene variants . It is recommended that women trying to conceive start taking a folic acid supplement and continue with it a few months in to their pregnancy. The outcome of the experiment had adverse effects on the offspring of the rats who had the excessive dose of folic acid. Taking too much folic acid while pregnant may put daughters at risk of diabetes and obesity. A recent study published in An International Journal of Obstetrics and Gynaecology (BJOG) suggests the optimal time for taking folic acid during pregnancy to reduce a child’s risk for small gestational age (SGA) at birth is before becoming pregnant.


Taking folic acid before conception led to fewer incidences of SGA compared to starting supplementation after conception. While folic acid supplements are highly recommended for women trying to get pregnant, women who are not trying to become pregnant should also consider a steady supplementation to promote healthy cell growth. With an increasingly obese population and folate recommendations based on studies from the 1990s, they surmise that obese mothers may need more folate during pregnancy. The study, published in the International Journal of Obesity earlier this month, shows that there’s a significant difference between the two groups.
Folate can reduce these rare neural tube defects from about 2 in 1,000 births to about 1 in 1,000, according to the Office of Dietary Supplements. Preventive Services Task Force and Office of Dietary Supplements have recommended 400 to 800 micrograms of folic acid for women of child-bearing age since 1996, and USPSTF reaffirmed the recommendation in 2009. Previous analytical studies haven’t tracked folate use and status in particular, especially by marking trimesters through red blood cell data.
In fact, a study published in the journal PLOS One, shows that a common gene variant that prevents folate conversion is a risk factor for neural tube defects. Many women get tested when they find out they’re pregnant or if they’re struggling with infertility, but it’s better to be proactive and get the testing beforehand if you want to know for sure, Gottfried said. Previous studies have shown that rates of women taking folic acid before conception are somewhere between 14.8 and 31 percent.
Red blood count folate status, which indicates the actual presence of folate in the blood, was also lowest in the first trimester and highest in the third trimester. USPSTF reviews recommendations every five years, and folic acid isn’t currently on the list for USPSTF to update.



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