Nourishing Mothers-to-Be and Babies-to-Come
Babies are beautiful. How amazing that a fertilized egg can transform over 9 months into a wiggling, sometimes screaming, little being! After birth, it seems like the parental challenges of feeding, comforting, and nurturing begin but maternal nutrition has already had a major developmental impact.
Increased folate levels in women during the first trimester of pregnancy is associated with reduced risk of birth defects. Maternal folate status may affect the risk of a preterm birth. Chen and colleagues measured plasma concentrations of folate, vitamins B6 and B12, in maternal blood at the beginning of the third trimester (gestational weeks 26-28) in 999 women of Chinese, Malay and Indian descent living in Singapore. Only 3% were folate deficient (< 6.8 nmol/L) and 11% marginally deficient (< 13.6 nmol/L), presumably because 90% were using folate-containing supplements. Despite good folate status, higher folate concentrations were associated with lower risk of short gestational age and lower risk of premature birth.
Women of child-bearing age have an increased risk of micronutrient deficiencies. Iron deficiency anemia is the most prevalent in the United States. Fayet-Moore and associates collected blood from 308 young women (18-35y) living in Australia. Low iron status was the most common (33%) and 11% had low serum B12 concentrations. The folic acid fortification program has increased serum folate concentrations in Australia but more than 1/3 of women still had serum folate levels <906 nmol/L, the cutoff associated with a high risk of neural tube defects. These findings are not unique to women from Australia or Singapore. Thirty-nine percent of Belgian women and 22% of Canadian women have folate concentrations below maximally protective levels for unborn children. These circumstances may be exacerbated in women with a higher body mass index because serum folate levels are lower in obese women and their response to an oral dose is lower.
In summary, good nutrition results in healthy pregnancies. Folic acid is an essential nutrient for normal child development. McNulty and others recommend continued supplementation with 400 µg folic acid daily in the 2nd and 3rd trimesters to help maintain normal maternal homocysteine levels.
Chen L-W, Lim AL, Colega M, Tint M-T, Aris IM, Tan CS, Chong Y-S, Gluckman PD, Godfrey KM, Kwek K, Saw S-M, Yap F, Lee YS, Chong MF-F, van Dam RM. Maternal folate status, but not that of vitamins B12 or B6, is associated with gestational age and preterm birth risk in a multiethnic Asian population. 2014 J Nutr doi: 10.3945/jn.114.196352
Fayet-Moore F, Petocz P, Samman S. Micronutrient status in female university students: iron, zinc, copper, selenium, vitamin B12 and folate. 2014 Nutr doi: 10.3390/nu61151013
McNulty B, McNulty H, Marshall B, Ward M, Molloy AM, Scott JM, Dornan J, Pentieva K. Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of folic acid supplementation in the second and third trimesters. 2013 Am J Clin Nutr doi: 10.3945/ajcn.112.057489
Vandevijvere S, Amsalkhir S, Van Oyen H, Moreno-Reyes R. Determinants of folate status in pregnant women: results from a cross-national survey in Belgium. 2012 EJCN doi: 10.1038/ejcn.2012.111
Colapinto CK, O’Connor DL, Tremblay MS. Folate status of the population in the Canadian Health Measures Survey. 2011 CMAJ doi: 10.1503/cmaj.100568
Da Silva VR, Hausman DB, Kauwell GPA, Sokolow A, Tackett RL, Rathburn Sl, Bailey LB. Obesity affects short-term folate pharmacokinetics in women of childbearing age. 2013 Int J Obes doi: 10.1038/ijo.2013.41