Healthy nutrition and active folate supplementation pegged as crucial for pregnant women

05 Dec 2019 --- New research indicates that expectant mothers may not be receiving sufficiently adequate nutrition during preconception and pregnancy. This is according to an analysis of a number of studies published in the journal Maternal and Child Nutrition. Responding to this need for healthy nutrition before and during pregnancy, a separate study suggests that active folate supplementation may be more beneficial to fetuses’ development than folic acid.

“The relationship between a healthy diet and birth outcomes is well-established, yet our research suggests women may not be following the guidelines developed to help them eat well, largely because they are unaware of the guidelines in the first place. Promoting links between diet and healthy pregnancy and birth, as well as increasing support for health professionals, may help better inform women and their partners about the importance of dietary choices on pregnancy success,” says corresponding author Cherie Caut of Endeavour College of Natural Health, Australia.

In particular, preconceptual and pregnant women may not be consuming enough vegetables, cereal grains, folate, iron and calcium, while consuming excess fat. The analysis found that pregnant women did not meet iron or calcium intake requirements in 91 percent and 55 percent of studies respectively, and also exceeded fat intake recommendations in 55 percent of studies.

The analysis emphasizes that dietary guidelines exist to promote health and wellbeing through the prevention of diet‐related disorders and nutritional deficiencies. It recommends adhering to these guidelines as they can assure that energy, macronutrient and micronutrient intake are adequate to support fertility, pregnancy and positive birth outcomes, as well as the future health of the offspring. 

In the future, understanding the factors associated with both adherence and non‐adherence can inform future nutrition policy and practice aimed at improving overall dietary guideline compliance. Moreover, nutrition education and counseling may also improve compliance. However, further studies are needed to determine how the intervention translates to maternal and infant health outcomes.

Supplementation with active folate
Conducting research on how to serve pregnant women best, a study published in The Journal of Maternal-Fetal & Neonatal Medicine found that 5-methyltetrahydrofolate (5-MTHF) is the most physiologic prevalent folate in both cord and maternal plasma. However, the greater concentration of tetrahydrofolate (THF) in cord blood relative to maternal blood sheds light on how folate metabolism differs in the specific context of fetal development and physiology. 

As the awareness of the role of active folate grows, the scientific community has been hypothesizing whether the use of active folate is better than folic acid. “It is true that folic acid is beneficial to pregnant women’s health, but now we have something that could be more effective and safer,” Lorna Carboni, Product Support Specialist of Gnosis by Lesaffre, tells NutritionInsight.

5-MTHF plays a critical role in both maternal and fetal folate-mediated processes during pregnancy. 5MTHF feeds into the S-adenosyl methionine cycle that supplies methyl donors for DNA methylation, thereby affecting genetic expression, the study says.

It also found that 5MTHF may be a better repletion strategy than folic acid among reproductive females. Folic acid has to be de-glutamated and reduced before eventually being converted to 5MTHF and can enter the folate cycle. However, by bypassing these additional steps, 5MTHF may offer a more direct form of supplementation that positively affects the fetus. 

“Supplementation is extremely important to ensure there are no problems during the development of the fetus. This can depend on the availability of active folate,” she adds. 

The study further highlights the need for research to be conducted exploring fetal folate utilization and optimizing perinatal outcomes through personalized folate repletion strategies in the future.

Earlier this year, the International Alliance of Dietary/Food Supplement Associations, highlighted that further education is necessary to fill the gap between recommended and actual nutrient intake in order to ensure that pregnant women and babies have adequate folate levels.

By Anni Schleicher