Prenatal diet and lifestyle advice key to children's health, The Lancet emphasizes

24 Apr 2018 --- A series of articles published this week in the Lancet has further underlined the evidence around the importance of preconception diet, nutrition and lifestyle of parents to the health of their children. The research reinforces the need for nutritional advice and support for women trying to conceive from qualified professionals such as dietitians. Not only do women need to improve iron and folate status but other factors such as obesity, caffeine intake and malnutrition are shown to increase the risk of various diseases in unborn children.

Using data from 509 women of reproductive age (18-42) in the UK National Diet and Nutrition Survey, the report authors estimate that many UK women are not nutritionally prepared for pregnancy, and 96 percent of women in that age group have iron and folate dietary intakes below the recommendation for pregnancy (14.8mg per day, and 400µg per day, respectively).

The report authors encourage a range of interventions at the public health level as well as at the individual level, which span the whole life course. They emphasize that interventions need to begin early in the preconception period, if not before. This is particularly important when up to 40 percent of pregnancies are thought to be unplanned.

Folate and folic acid are key to a healthy prenatal diet. Over the past months, discussions regarding their benefits for women have increased. In January, UK researchers reported that there is no need for an upper limit of folate intake as the maximum suggested intake of folate (1 mg/day) is based on a “flawed” analysis. Their findings support recent calls for the UK Department of Health to approve the fortification of flour with folic acid, to protect babies from having neural tube defects.

Anencephaly and spina bifida (collectively referred to as neural tube defects) are relatively common but serious birth defects, affecting 1 in every 500-1,000 pregnancies. In 1991, a Medical Research Council randomized trial showed that increasing folic acid intake immediately before and early in pregnancy prevented most cases of neural tube defects.

As a result, 81 countries, including the US since 1998, have introduced mandatory folic acid fortification of cereals, which has been found to reduce the prevalence of neural tube defects, without any evidence of harm. In countries that have introduced fortification, the number of neural tube defects has decreased by up to a half.

The British Dietetic Association (BDA) reported that is strongly supports the mandatory fortification of flour with folic acid in order to increase the intake of folate and reduce the risk of neural tube defects in pregnancy, which currently affect around 16 families a week in the UK.

Recently, the Council for Responsible Nutrition (CRN), a US trade association for the dietary supplement and functional food industry, has issued a statement calling attention to the benefits of folic acid for all women of childbearing age. The statement came in response to a study, “Association of Folic Acid Supplementation During Pregnancy With the Risk of Autistic Traits in Children Exposed to Antiepileptic Drugs In Utero,” published in January in JAMA (Journal of the American Medical Association) Neurology.

“Supplementing with folic acid by women who are pregnant, or capable of becoming pregnant, has proven essential to reduce neural tube birth defects in babies, and this new study demonstrates the potential for additional benefits of continuous folic acid supplementation,” Andrea Wong, Ph.D., vice president, scientific & regulatory affairs, CRN, says in the statement.