23.04.2015

Low folic acid and pregnancy

Folic acid is a water-soluble vitamin of the B Group and it is the only active form of folate absorbed by the body.It is synthetically produced,because it is not naturally found in food,contrary to folate. Folic acid structure is composed of the union of three molecules: 6-metilpterina acid, p-amino benzoic acid (PABA), and glutamic acid. Folate enter cells as monoglutamates, but are rapidly modified by addition of four to eight glutamate residues to form long side chains.
The enzyme 5,10- metiltetridrofolato reductase ( 5,10- MTHFR ) is an enzyme dependent on folic acid that exists in polymorphic form ( genetic polymorphism ).
From the earliest stages of pregnancy , the product of conception becomes a huge consumer of folate, because of the intense processes of cell proliferation and differentiation.
The integration with folic acid does not reset the risk that the product of conception developments defects in neural tube closure , but it significantly reduces. Neural tube defects are severe abnormalities of the central nervous system that develop in babies during the first few weeks of pregnancy and that resulting in malformations of the spine, skull, and brain; the most common neural tube defects are spina bifida and anencephaly.
If the event occurs before the closure of the neural tube (the fourth week of embryonic development) we have the open spina bifida, which is incompatible with life, characterized by the absence of skin, vertebral arches, meninges, and exposure of the neural tube. Folic acid fortification is a process where folic acid is added to flour with the intention of promoting public health through increasing blood folate levels in the populace.Since the discovery of the link between insufficient folic acid and neural tube defects, governments and health organizations worldwide have made recommendations concerning folic acid supplementation for women intending to become pregnant.


A group of zinc-dependent intracellular enzymes, the conjugase , are used to obtain folic acid, which is the form normally absorbed from the gut, and then, folic acid is further reduced by the enzyme 5,10- metiltetridrofolato reductase (5,10- MTHFR) in the liver to 5MTHF (5-Methyl-Tedra hydro-folate) that is the active form of the vitamin itself, responsible for significant biological activities known and that is obteined after reduction in diidrofolic acid by diidrofolate reductase. The reasons may be related to infectious diseases, drug therapies, pregnancy or malabsorption, and the consequences are problems in the synthesis of DNA and RNA , but also defects in production of bone marrow cells.Folate is required to make red blood cells and white blood cells and folate deficiency may lead to anemia.
The increase in maternal erythropoiesis contributes to the needs of folic acid during pregnancy in view of childbirth blood volume will be increased by 30-50%.
Women who could become pregnant are advised to eat foods fortified with folic acid or take supplements in addition to eating folate-rich foods to reduce the risk of serious birth defects.
More than 50% ofall pregnant women suffer anemia duringpregnancy.9 May 2013 Osama wardaIron deficiency anemia is the most commontype, followed by blood loss due to obstetriccause, and anemia due to chronic infection. The food folates are absorbed mainly in the first intestinal tract, including the duodenum and the ileum, and in the proximal third of the small intestine, although they may be absorbed throughout its length. The foletes that are used ase coenzymes and regulatory molecules in the body are all in the reduced form as tetrahydrofolate derivetes. For this reason folic acid is required for all the reactions of DNA synthesis, repair and methylation , for RNA synthesis, for the metabolism of homocysteine and other important biochemical reactions, particularly during erythropoiesis, the process of formation of red blood cells, and in periods of rapid cell division.For this reason, both children and adults require folic acid to produce normal red blood cells and prevention of anemia.
The World Health Organization (OMS) recommends a daily intake of 400 micrograms in pregnancy in order to prevent the occurrence of spina bifida and 300 micrograms during breastfeeding.


But the capacity of the body to convert folic acid is limited and unmetabolised folic acid has been detected in the systemic circulation following folic acid supplement.
For this reason , the deficiency of folic acid can increase preeclampsia and eclampsia , recurrent miscarriage , placental abruption , intrauterine growth retardation , low birth weight and intrauterine death .Therefore this deficiency is associated with many pregnancy complications. Is essential that this assumption beginning one month before conception (to increase reserves) and continues throughout the first trimester of pregnancy. Indeed, with a proper nutritional intake of folic acid, the presence of 5,10-optimal MTHFR protects from the risk of an incorrect development embryogenetic.
This particular dosage of folic acid is recommended to all the people of childbearing age who do not apply effective contraceptive measures.
On the contrary, a low intake of folic acid and consequent reduced production of the enzyme that is involved in the 5,10-MTHFR dall'dUMP proper conversion to dTMP, causes an increase in the incorporation of uracil into DNA with an increase in genomic instability . But Ddoses higher than 0.4 mg of folic acid per day may be specifically recommended only for women who have already had a child affected by defects in neural tube closure , or a family history of such malformations.



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