• Supplementation of Effective Protective Folic Acid Concentrations for Perinatal Complications Prevention
en To content Full text of article

Supplementation of Effective Protective Folic Acid Concentrations for Perinatal Complications Prevention

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.4(76):17-20; doi 10.15574/PP.2018.76.17

Davydova Iu. V.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after аcademician O. Lukyanova of the National Academy of Medical Sciences of Ukraine»,
Kyiv

Given the increased frequency of comorbidity in pregnant women over the past twenty years, including diseases that hinder folate absorption from food, it is necessary to inform the public and health care providers about the importance of taking 0.8 mg/day of folic acid to ensure an effective protective dose in the blood of women who are planning pregnancy. Taking into account the lack of pregnancy planning in half of cases in our country and the short window for potential positive impact for the prevention of neural tube defects during pregnancy, it is advisable to use medical certified multivitamin complex with folic acid content of 0.8 mg/day (Elevit Pronatal) immediately after intrauterine pregnancy is diagnosed. In case of identified genes polymorphisms, which are encoding folate metabolism and receptor activation, 0.8 mg/day of folic acid should be prescribed to women in the preconception period, at the stage of organogenesis and placentogenesis. It is advisable to disseminate information about the need to take certified vitamin-mineral complex by women of reproductive age when they apply for any kind of medical care to primary care physicians, as well as during routine examinations or calls for gynecological help to obstetrician gynecologists.

Key words: prevention of perinatal complications, folic acid.

REFERENCES

1. Bailey LB. (2010). Folate in Health and Disease. 2nd ed. Boca Raton: Taylor & Francis: 602. PMid:21039563

2. Botto LD, Yang Q. (2000). 5,10-Methylenetetrahydrofolate reductase gene variants and congenital anomalies: a HuGE review. Am J Epidemiol. 151(9): 862–877. https://doi.org/10.1093/oxfordjournals.aje.a010290; PMid:10791559

3. Crider KS, Devine O, Hao L et al. (2014, Jul. 29). Population red blood cell folate concentrations for prevention of neural tube defects: Bayesian model. BMJ. 349: 4554. https://doi.org/10.1136/bmj.g4554.

4. Czeizel AE, Dudas I. (1992). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 327(26): 1832–1835. https://doi.org/10.1056/NEJM199212243272602; PMid:1307234

5. Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM. (1995). Folate levels and neural tube defects. Implications for prevention. JAMA. 274(21): 1698–1702. https://doi.org/10.1001/jama.274.21.1698; https://doi.org/10.1001/jama.1995.03530210052030; PMid:7474275

6. De Marco P, Calevo MG, Moroni A et al. (2002). Study of MTHFR and MS polymorphisms as risk factors for NTD in the Italian population. J Hum Genet. 47(6): 319–324. https://doi.org/10.1007/s100380200043; PMid:12111380

7. De Marco P, Merello E, Calevo MG et al. (2006). Evaluation of a methylenetetrahydrofolate-dehydrogenase 1958G > A polymorphism for neural tube defect risk. J Hum Genet. 51(2): 98–103. https://doi.org/10.1007/s10038-005-0329-6; PMid:16315005

8. FIGO Working Group on Best Practice in Maternal-Fetal Medicine. (2015). Best practices in maternal fetal medicine. Int J Gynecol Obstet. 128: 80–82. https://doi.org/10.1016/j.ijgo.2014.10.011; PMid:25481030

9. Johnson WG, Stenroos ES, Spychala JR et al. (2004). New 19 bp deletion polymorphism in intron-1 of dihydrofolate reductase (DHFR): a risk factor for spina bifida acting in mothers during pregnancy? Am J Med Genet A. 124A(4): 339–345. https://doi.org/10.1002/ajmg.a.20505; PMid:14735580

10. Lamers Y, MacFarlane AJ, O'Connor DL, Fontaine-Bisson B. (2018, Dec 1). Periconceptional intake of folic acid among lowrisk women in Canada: summary of a workshop aiming to align prenatal folic acid supplement composition with current expert guidelines. Am J Clin Nutr. 108(6): 1357–1368. https://doi.org/10.1093/ajcn/nqy212; PMid:30541097 PMCid:PMC6290364

11. Ly A, Hoyt L, Crowell J, Kim YI. (2012). Folate and DNA methylation. Antioxid Redox Signal. 17(2): 302–326. https://doi.org/10.1089/ars.2012.4554; PMid:22332737

12. Shere M, Bapat P, Nicke LC, Kapur B, Koren G. (2015). Association between folate status and use of oral contraceptives: a systematic review and meta-analysis. J Obstet Gynaecol Can. 37(5): 430–438. https://doi.org/10.1016/S1701-2163(15)30258-9

13. Steger GG, Mader RM, Vogelsang H, Schofl R, Lochs H, Ferenci P. (1994). Folate absorption in Crohn's disease. Digestion. 55(4): 234–238. https://doi.org/10.1159/000201153; PMid:8063027

14. Wald NJ, Law MR, Morris JK, Wald DS. (2001). Quantifying the effect of folic acid. Lancet. 358(9298): 2069–2073. https://doi.org/10.1016/S0140-6736(01)07104-5

15. Williams J, Mai CT, Mulinare J et al. (2015). Updated estimates of neural tube defects prevented by mandatory folic acid fortification — United States, 1995–2011. MMWR Morbid Mortal Wkly Rep. 64(1): 1–5. PMid:25590678 PMCid:PMC4584791

Article received: Aug 12, 2018. Accepted for publication: Dec 03, 2018.