Journal Mobile Options
Table of Contents
Vol. 59, No. 1, 2011
Issue release date: November 2011

Folate Recommendations for Pregnancy, Lactation, and Infancy

Lamers Y.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

An adequate intake of folate during pregnancy, lactation, and infancy is essential for maternal and child health and normal growth. Higher folate requirements during pregnancy and lactation are difficult to meet by increased intake of folate-rich food products only. Supplementation with folic acid is recommended not only to meet the higher requirements but also to prevent adverse pregnancy outcomes such as neural tube defects (NTDs). In countries that have implemented food fortification with folic acid, the folate intake has raised but does not yet meet the recommended amount for NTD risk reduction. Women’s awareness of the need to supplement with folic acid prior to conception shall be raised in all countries. It is under debate whether a high folic acid intake might have metabolic and functional effects in utero and for the infant. Research is needed to investigate potential alternative folate forms for food fortification programs and to test their efficacy in risk reduction of adverse pregnancy outcomes. Breast-fed infants most likely receive sufficient folate. While the folate level of human milk is simulated in infant formula, data are lacking on the bioavailability and effect of folic acid in infants and on whether a tolerable upper intake level should be defined.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Scholl TO, Johnson WG: Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr 2000;71:1295S–1303S.
  2. Reynolds E: Vitamin B12, folic acid, and the nervous system. Lancet Neurol 2006;5:949–960.
  3. Lamers Y: Indicators and methods for folate, vitamin B-12, and vitamin B-6 status assessment in humans. Curr Opin Clin Nutr Metab Care 2011;14:445–454.
  4. Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM: Folate levels and neural tube defects: implications for prevention. JAMA 1995;274:1698–1702.
  5. Kauwell GPA, Diaz ML, Yang Q, Bailey LB: Folate: Recommended Intakes, Consumption, and Status. In: Folate in Health and Disease. Edited by Bailey LB, 2nd edn. Boca Raton, FL: CRC Press; Taylor & Francis Group; 2010: 467-490.
  6. German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research, Swiss Nutrition Association: Reference Values for Nutrient Intake. 1st edn.; Umschau Braus GmbH/German Nutrition Society, Frankfurt/Main, Germany: 2002.
  7. Health Council of the Netherlands: Towards an Optimal Use of Folic Acid. publication no. 2008/02E: Health Council of the Netherlands, The Hague, Netherlands; 2008.
  8. Department of Health: Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects, No. 41. HMSO, London, UK, 1991; Scientific Advisory Committee on Nutrition. Folate and Disease Prevention. The Stationery Office, Norwich, UK, 2006.
  9. Food Safety Authority of Ireland RDA Working Group: Recommended Dietary Allowances for Ireland. Food Safety Authority of Ireland, Dublin, Ireland; 1999.
  10. Nordic Council of Ministers: Nordic Nutrition Recommendations 2004: Integrating Nutrition and Physical Activity. 4th edn.; Nordic Council of Ministers, Copenhagen, Denmark: 2005.
  11. Institute of Medicine – Food and Nutrition Board: Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academy Press; Washington D.C.: 1998.
  12. Australian National Health and Medical Research Council, New Zealand Ministry of Health: Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. National Health and Medical Research Council; Canberra, Australia: 2006.
  13. Food and Agriculture Organization: World Health Organization: United Nations: Report of a Joint FAO/WHO Expert Consultation. Folate and Folic Acid. Human Vitamin and Mineral Requirements. FAO/WHO; Rome, Italy: 2004.
  14. Caudill MA, Cruz AC, Gregory JF, 3rd, Hutson AD, Bailey LB: Folate status response to controlled folate intake in pregnant women. J Nutr 1997;127:2363–2370.
  15. Cuskelly GJ, McNulty H, Scott JM: Effect of increasing dietary folate on red-cell folate: implications for prevention of neural tube defects. Lancet 1996;347:657–659.
  16. Wild J, Schorah CJ, Maude K, Levene MI: Folate intake in young women and their knowledge of preconceptional folate supplementation to prevent neural tube defects. Eur J Obstet Gynecol Reprod Biol 1996;70(2):185-189.
  17. O’Brien MM, Kiely M, Harrington KE, Robson PJ, Strain JJ, Flynn A: The North/South Ireland Food Consumption Survey: vitamin intakes in 18-64-year-old adults. Public Health Nutr 2001;4(5A):1069-1079.
  18. Rouget F, Monfort C, Bahuau M, Nelva A, Herman C, Francannet C, Robert-Gnansia E, Cordier S: [Periconceptional folates and the prevention of orofacial clefts: role of dietary intakes in France]. Rev Epidemiol Sante Publique 2005;53(4):351-360.
  19. Franke C, Verwied-Jorky S, Campoy C, Trak-Fellermeier M, Decsi T, Dolz V, Koletzko B: Dietary intake of natural sources of docosahexaenoic acid and folate in pregnant women of three European cohorts. Ann Nutr Metab 2008;53(3-4):167-174.
  20. Rasmussen LB, Ovesen L, Bulow I, Knudsen N, Laurberg P, Perrild H: Folate intake, lifestyle factors, and homocysteine concentrations in younger and older women. Am J Clin Nutr 2000;72(5):1156-1163.
  21. Pinto E, Barros H, dos Santos Silva I: Dietary intake and nutritional adequacy prior to conception and during pregnancy: a follow-up study in the north of Portugal. Public Health Nutr 2009;12(7):922-931.
  22. Navarrete-Munoz EM, Gimenez Monzo D, Garcia de La Hera M, Climent MD, Rebagliato M, Murcia M, Iniguez C, Ballester F, Ramon R, Vioque J: [Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain]. Med Clin (Barc) 2010;135(14):637-643.
  23. Sofi F, Vecchio S, Giuliani G, Martinelli F, Marcucci R, Gori AM, Fedi S, Casini A, Surrenti C, Abbate R et al: Dietary habits, lifestyle and cardiovascular risk factors in a clinically healthy Italian population: the ‘Florence’ diet is not Mediterranean. Eur J Clin Nutr 2005;59(4):584-591.
  24. Shuaibi AM, House JD, Sevenhuysen GP: Folate status of young Canadian women after folic acid fortification of grain products. J Am Diet Assoc 2008;108(12):2090-2094.
  25. Cena ER, Joy AB, Heneman K, Espinosa-Hall G, Garcia L, et al: Folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age. J Am Diet Assoc 2008;108:1364–1368.
  26. Czeizel AE, Dudas I: Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832–1835.
  27. Bramswig S, Prinz-Langenohl R, Lamers Y, Tobolski O, Wintergerst E, et al: Supplementation with a multivitamin containing 800 microg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res 2009;79:61–70.
  28. Lamers Y, Prinz-Langenohl R, Bramswig S, Pietrzik K: Red blood cell folate concentrations increase more after supplementation with [6S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. Am J Clin Nutr 2006;84:156–161.
  29. McDowell MA, Lacher DA, Pfeiffer CM, Mulinare J, Picciano MF, et al: Blood folate levels: the latest NHANES results. NCHS Data Brief 2008, pp 1–8.
  30. Colapinto CK, O’Connor DL, Tremblay MS: Folate status of the population in the Canadian Health Measures Survey. CMAJ 2010;183:E100–E106.

    External Resources

  31. Shakur YA, Garriguet D, Corey P, O’Connor DL: Folic acid fortification above mandated levels results in a low prevalence of folate inadequacy among Canadians. Am J Clin Nutr 2010;92:818–825.
  32. Melikian V, Paton A, Leeming RJ, Portman-Graham H: Site of reduction and methylation of folic acid in man. Lancet 1971;2:955–957.
  33. Bailey SW, Ayling JE: The extremely slow and variable activity of dihydrofolate reductase in human liver and its implications for high folic acid intake. Proc Natl Acad Sci USA 2009;106:15424-15429.
  34. Fohr IP, Prinz-Langenohl R, Brönstrup A, Bohlmann AM, Nau H, et al: 5,10-Methylenetetrahydrofolate reductase genotype determines the plasma homocysteine-lowering effect of supplementation with 5-methyltetrahydrofolate or folic acid in healthy young women. Am J Clin Nutr 2002;75:275–282.
  35. Kelly P, McPartlin J, Goggins M, Weir DG, Scott JM: Unmetabolized folic acid in serum: acute studies in subjects consuming fortified food and supplements. Am J Clin Nutr 1997;65:1790–1795.
  36. Leeming RJ, Portman-Graham H, Blair JA: The occurrence of folic acid (pteroyl-L-monoglutamic acid) in human blood serum after small oral doses. J Clin Pathol 1972;25:491–493.
  37. Lamers Y: [6S]-5-Methyltetrahydrofolate Compared to Folic Acid Supplementation: Effect on Risk Markers of Neural Tube Defects. Goettingen, Cuvillier, 2006, pp 159.
  38. Sweeney MR, McPartlin J, Weir DG, Daly L, Scott JM: Postprandial serum folic acid response to multiple doses of folic acid in fortified bread. Br J Nutr 2006;95:145–151.
  39. Troen AM, Mitchell B, Sorensen B, Wener MH, Johnston A, et al: Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women. J Nutr 2006;136:189–194.
  40. Matthews RG, Baugh CM: Interactions of pig liver methylenetetrahydrofolate reductase with methylenetetrahydropteroylpolyglutamate substrates and with dihydropteroylpolyglutamate inhibitors. Biochemistry 1980; 19:2040-5.
  41. Shields DC, Kirke PN, Mills JL, Ramsbottom D, Molloy AM, et al: The ‘thermolabile’ variant of methylenetetrahydrofolate reductase and neural tube defects: an evaluation of genetic risk and the relative importance of the genotypes of the embryo and the mother. Am J Hum Genet 1999;64:1045–1055.
  42. van der Put NM, Steegers-Theunissen RP, Frosst P, Trijbels FJ, Eskes TK, et al: Mutated methylenetetrahydrofolate reductase as a risk factor for spina bifida. Lancet 1995;346:1070–1071.
  43. Houghton LA, Sherwood KL, Pawlosky R, Ito S, O’Connor DL: [6S]-5-Methyltetrahydrofolate is at least as effective as folic acid in preventing a decline in blood folate concentrations during lactation. Am J Clin Nutr 2006;83:842–850.
  44. Houghton LA, Sherwood KL, O’Connor DL: How well do blood folate concentrations predict dietary folate intakes in a sample of Canadian lactating women exposed to high levels of folate? An observational study. BMC Pregnancy Childbirth 2007;7:25.
  45. Houghton LA, Yang J, O’Connor DL: Unmetabolized folic acid and total folate concentrations in breast milk are unaffected by low-dose folate supplements. Am J Clin Nutr 2009:89:216–220.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50