Nutrition During Pregnancy and Lactation Exploring New Evidence: Proceedings of a Workshop (2020) / Chapter Skim
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3 One-Carbon Metabolism Micronutrients
3 One-Carbon Metabolism Micronutrients
Pages 25-38
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From page 25... ...
Highlights from the session presentations are presented in Box 3-1. DISCREPANCIES IN FOLATE AND VITAMIN B12 STATUS OF PREGNANT WOMEN ACROSS POPULATION GROUPS AND THE POSSIBLE IMPLICATIONS FOR CHILD OUTCOMES In her remarks, Yvonne Lamers, associate professor in the Food, Nutrition and Health program at The University of British Columbia, provided 1 One-carbon metabolism encompasses interrelated biochemical reactions that involve the transfer of 1-carbon units (methyl groups)
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From page 26... ...
Folic Acid Supplementation and Fortification One of the biggest milestones in maternal nutrition that has taken place over the past 30 years is the recognition that periconceptional folic acid can prevent neural tube defects, said Lamers. First released in the early 1990s, recommendations for preconceptual folic acid supplementation were driven by results from two randomized controlled trials that found supplementing low-risk women reduced the incidence of neural tube defects by at least
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From page 27... ...
. Current guidelines generally recommend that women of reproductive age who have a low risk of giving birth to a baby with neural tube defects take a 400 μg/day folic acid supplement at least 1 month prior to conception through 12 weeks gestation.
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Birth and Child Developmental Outcomes Related to Prenatal Folic Acid Intake Studies have investigated relationships between prenatal folic acid intake and a variety of birth and developmental outcomes. There appears to be no association between folic acid supplementation and birth weight, risk of preterm birth, or stillbirths and neonatal deaths (Lassi et al., 2013)
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In addition to its role in the closure of the neural tube in the first weeks of pregnancy, folate is a key nutrient for brain function. Observational s tudies have reported either positive or no associations between maternal folate status in early or late pregnancy and child behavioral outcomes, reported Lamers.
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Recognizing low vitamin B12 status is an independent risk factor for neural tube defect, she suggested vitamin B12 trials using different doses were needed to determine a dose–response relationship. Noting that the dietary intake data suggest many pregnant women meet or exceed existing intake recommendations, she emphasized the need to identify women at risk of inadequate
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THE GROWING SCIENCE ON THE BENEFITS OF CHOLINE FOR MOTHERS AND INFANTS Marie Caudill, professor in the Division of Nutritional Sciences at Cornell University, described the role of choline in fetal development. Caudill also provided an overview of the changes to choline metabolism during pregnancy, reviewed evidence on the relationship between choline intake during pregnancy and a range of outcomes, presented on choline intake levels among pregnant women in the United States, and discussed postnatal demands for choline.
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First, pregnant women spare free choline for
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Evidence from studies of nonpregnant women of reproductive age indicates that choline and DHA have a synergistic relationship. As choline intake increases, the PEMT-choline pathway is upregulated and hepatic DHA export increases (West et al., 2013)
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Choline Intake Levels Only 8 percent of pregnant women have intakes that meet the holine c Adequate Intake (AI)
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Topics explored included clinical considerations related to choline, recommendations for choline intake and supplementation, dose and formulation of folic acid supplementation, and considerations of folic acid in the food supply. Clinical Considerations Related to Choline Hatfield opened the discussion by admitting that choline was not a nutrient she assesses in her obstetric patients and wondered if choline should be included in routine prenatal labs.
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and Canadian prenatal supplements is historical. Hatfield also wondered what dose of folic acid supplementation should be given to a woman who has had neural tube defects in prior pregnancies.
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increases red blood cell folate concentrations more than an equimolar amount of folic acid. She con tinued by stating that neural tube defects have been shown to be prevented by 400 μg/day folic acid, so it is unethical to recommend a different folate form, as the mechanisms underlying its protective effects are not well understood.
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