Prenatal and natal nutrition: Folate in focus

02 May 2018 --- One of the stages of life that arguably requires particular nutrient attention is pregnancy, as a woman’s body creates an environment to nourish and grow a baby. Crucial to creating a coherent nutritional profile during this time is folate, or folic acid. NutritionInsight shines a light on this nutrient and its importance in pregnancies.

Regarding terminology, folate is a B-vitamin that is naturally occurring in many foods, while a synthetic form of folate – called folic acid – is used in dietary supplements and fortified foods. 

Folic acid is found naturally in foods including vegetables (especially dark green leafy vegetables), nuts, beans, peas, grains, fruits and fruits juices. However, processes such as cooking can reduce the levels of folate in foods, as it is a water-soluble vitamin. This can be reduced by avoiding over-cooking and steaming or microwaving vegetables instead of boiling.

While men, children and most women should be able to get adequate levels of folate from these naturally occurring sources, pregnant women – or those seeking to become pregnant – may not, the Association of UK Dieticians says.

Folate's protective role in pregnancy
Folate deficiency at the time of conception can have a damaging effect on fetal development. It can increase the likelihood of having a premature or low-birth-weight baby and increase chances of neural tube defects at birth, for example.

“Folate is needed to make DNA and other genetic material. It is especially important during times of rapid cell growth. During pregnancy, getting enough folic acid helps prevent neural tube defects which are birth defects that result in malformations of the spine, skull and brain,” Carol Haggans, Scientific and Health Communications Consultant, Office of Dietary Supplements, National Institute of Health (NIH), tells NutritionInsight. 

However, such birth defects can potentially form extremely early on in the pregnancy, often before a woman may even know she is pregnant, therefore, for the benefit to be received, folate levels must be optimum around the time of conception. 

Because of the difficulty in predicting conception, the “recommendation in the US is that all women of childbearing age capable of becoming pregnant should take folic acid,” James L. Mills, Senior Investigator at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, tells NutritionInsight.

In previous research conducted by Mills, it was stated that a 1991 finding demonstrated that women who took folic acid supplements prior to conception, reduced their risk for having a child with neural tube defects by more than 50 percent.

However, since almost 40 percent of pregnancies are unplanned, some mothers were under prepared in terms of folate levels for the optimum fetal development. 

Such statistics have spurred recommendations that all women of child-bearing age should supplement with the nutrient, or, that foods can be fortified to supply an easy resource of folic acid. This was hoped to be particularly efficient as, “Our bodies absorb folic acid somewhat better than the folate found naturally in food,” Haggans adds. 

Folic fortification
In response to evidence supporting the critical role of folate in prenatal and natal nutrition, the US Food and Drug Administration began fortifying some foods with folic acid from 1998. These include enriched breads, cereals, flours, cornmeal’s, pastas, rice and other grain products.

“For over 25 years, many government and professional groups have recommended folic acid during pregnancy. Specifically, all women who could become pregnant should get 400 micrograms of folic acid a day from dietary supplements, fortified foods, or both in addition to consuming folate from natural food sources. During pregnancy, the recommended amount goes up to 600 micrograms a day,” Haggans explains.

In the US, “folic acid is added at a level of 140 micrograms of folic acid per 100g of the cereal grain product. Studies of people's folic acid intakes before and after fortification estimate that folic acid fortification has increased folic acid intakes by about 138 - 190 micrograms per day in addition to the amount people get from supplements and other food sources.”

However, this fortification is not mandatory in the UK. Moreover, it “has been prevented by concern about increasing cancer risks in older populations, as it can potentially mask anemia caused by vitamin B12 deficiency, and issues to do with removal of individual choice,” Dr. Mary Barker, PhD, Associate Professor of Psychology and lead author of the Lancet study, tells NutritionInsight.

“This is despite little evidence of negative effects from folic acid fortification and the UK’s Scientific Advisory Committee on Nutrition continuing to recommend mandatory folic.”

Despite hardline evidence demonstrating the benefits of folate at key stages, many women still fall short of the recommended dosage levels before and during pregnancy, especially in the UK.

In their report, Barker and her fellow authors call for fortification and routine supplementation to amend their findings that many women were falling below the recommended dietary intake of folate during pregnancy. They place a strong recommendation for the UK to implement “modern marketing techniques,” for example campaigns, that “would target emotions that are central to an individual’s identity in the case of preconception health, might involve targeting young men and women’s ambitions to be good parents.”

One to watch: Selenium
In light of recent clinical development, another micronutrient has come to the fore; Selenium. Biotech Company Cypress Systems compiled an extensive Executive Summary on selenium and pregnancy, highlighting the micronutrient’s role in a healthy pregnancy and infant development. Specifically, high-selenium yeast is thought to reduce the risk of preterm births and preeclampsia, the company notes, calling for further research and industry and consumer education over why standardized, body-ready selenium should be in maternal supplements.

“This important role that selenium plays in the development of a healthy baby is not surprising once one realizes that this micromineral is essential for optimal antioxidant protection, which protects every cell in the human body including DNA, as well as being essential for a healthy immune function, proper DNA synthesis, healthy thyroid hormone production, and thus metabolism, as well as reproduction,” Cypress Systems CEO Paul Willis tells NutritionInsight.

“Pregnant women with higher maternal selenium have an increased chance of having a healthy, full-term pregnancy along with the delivery of a healthy baby, including babies who have, or will have, higher cognitive function and neurological development having higher IQ’s and greater learning abilities.”

Willis asserts that although folic acid has typically received the most amount of attention in the sector, selenium may be just as important, if not even more important.

The landscape of prenatal and natal nutrition is extremely dense and varied, with new research highlighting the importance of different micronutrients. Essentially, all opportunities that include either formulating or improving current prenatal and postnatal supplements that optimize the nutrition of both the mother and child must be based on solid research and clinical knowledge.

By Laxmi Haigh