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Kadam I, Dalloul M, Hausser J, Vaday D, Gilboa E, Wang L, Hittelman J, Hoepner L, Fordjour L, Chitamanni P, Saxena A, Jiang X. Role of one-carbon nutrient intake and diabetes during pregnancy in children's growth and neurodevelopment: A 2-year follow-up study of a prospective cohort. Clin Nutr 2024; 43:1216-1223. [PMID: 38636347 DOI: 10.1016/j.clnu.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/21/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND & AIMS Both maternal metabolic dysregulation, e.g., gestational diabetes mellitus (GDM), and maternal supply of nutrients that participate in one-carbon (1C) metabolism, e.g., folate, choline, betaine, and vitamin B12, have been demonstrated to influence epigenetic modification such as DNA methylation, thereby exerting long-lasting impacts on growth and development of offspring. This study aimed to determine how maternal 1C nutrient intake was associated with DNA methylation and further, development of children, as well as whether maternal GDM status modified the association in a prospective cohort. METHODS In this study, women with (n = 18) and without (n = 20) GDM were recruited at 25-33 weeks gestation. Detailed dietary intake data was collected by 3-day 24-h dietary recall and nutrient levels in maternal blood were also assessed at enrollment. The maternal-child dyads were invited to participate in a 2-year follow-up during which anthropometric measurement and the Bayley Scales of Infant and Toddler Development™ Screening Test (Third Edition) were conducted on children. The association between maternal 1C nutrients and children's developmental outcomes was analyzed with a generalized linear model controlling for maternal GDM status. RESULTS We found that children born to mothers with GDM had lower scores in the language domain of the Bayley test (p = 0.049). Higher maternal food folate and choline intakes were associated with better language scores in children (p = 0.01 and 0.025, respectively). Higher maternal food folate intakes were also associated with better cognitive scores in children (p = 0.002). Higher 1C nutrient intakes during pregnancy were associated with lower body weight of children at 2 years of age (p < 0.05). However, global DNA methylation of children's buccal cells was not associated with any maternal 1C nutrients. CONCLUSIONS In conclusion, higher 1C nutrient intake during pregnancy was associated with lower body weight and better neurodevelopmental outcomes of children. This may help overcome the lower language scores seen in GDM-affected children in this cohort. Studies in larger cohorts and with a longer follow-up duration are needed to further delineate the relationship between prenatal 1C nutrient exposure, especially in GDM-affected pregnancies, and offspring health outcomes.
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Affiliation(s)
- Isma'il Kadam
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA; PhD Program in Biochemistry, Graduate Center of the City University of New York, New York, NY 10016, USA
| | - Mudar Dalloul
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jeanette Hausser
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA
| | - Doron Vaday
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA
| | - Ella Gilboa
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA
| | - Liang Wang
- Department of Public Health, Robbins College of Human Health and Sciences, Baylor University, Waco, TX 76711, USA
| | - Joan Hittelman
- Department of Psychology, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Lori Hoepner
- Department of Environmental and Occupational Health Sciences, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Lawrence Fordjour
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Pavani Chitamanni
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Anjana Saxena
- Department of Biology, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA
| | - Xinyin Jiang
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, Brooklyn, NY 11210, USA; PhD Program in Biochemistry, Graduate Center of the City University of New York, New York, NY 10016, USA.
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2
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Campbell SA, Dys SP, Henderson JMT, Bradley HA, Rucklidge JJ. Exploring the impact of antenatal micronutrients used as a treatment for maternal depression on infant temperament in the first year of life. Front Nutr 2024; 11:1307701. [PMID: 38711532 PMCID: PMC11073451 DOI: 10.3389/fnut.2024.1307701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Antenatal depression and maternal nutrition can influence infant temperament. Although broad-spectrum-micronutrients (BSM: vitamins and minerals) given above Recommended Dietary Allowances during pregnancy can mitigate symptoms of antenatal depression, their associated effects on infant temperament are unknown. One hundred and fourteen New Zealand mother-infant dyads (45 infants exposed to BSM during pregnancy (range of exposure during pregnancy: 12-182 days) to treat antenatal depressive symptoms (measured by Edinburgh Postnatal Depression Scale) and 69 non-exposed infants) were followed antenatally and for 12 months postpartum to determine the influence of in utero BSM exposure on infant temperament. The Infant Behavior Questionnaire-Revised: Very Short-Form assessed temperament at 4 (T1), 6 (T2) and 12 (T3) months postpartum via online questionnaire. Latent growth curve modeling showed BSM exposure, antenatal depression and infant sex did not statistically significantly predict initial levels or longitudinal changes in orienting/regulatory capacity (ORC), positive affectivity/surgency (PAS) or negative affectivity (NEG). Higher gestational age was positively associated with initial PAS, and smaller increases between T1 and T3. Breastfeeding occurrence was positively associated with initial NEG. Although not significant, BSM exposure exerted small, positive effects on initial NEG (β = -0.116) and longitudinal changes in ORC (β = 0.266) and NEG (β = -0.235). While BSM exposure did not significantly predict infant temperament, it may mitigate risks associated with antenatal depression. BSM-exposed infants displayed temperamental characteristics on par with typical pregnancies, supporting the safety of BSM treatment for antenatal depression.
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Affiliation(s)
- S. A. Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - S. P. Dys
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - J. M. T. Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - H. A. Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - J. J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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3
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Xu X, Zhang Z, Lin Y, Xie H. Risk of Excess Maternal Folic Acid Supplementation in Offspring. Nutrients 2024; 16:755. [PMID: 38474883 DOI: 10.3390/nu16050755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
Folate, also known as vitamin B9, facilitates the transfer of methyl groups among molecules, which is crucial for amino acid metabolism and nucleotide synthesis. Adequate maternal folate supplementation has been widely acknowledged for its pivotal role in promoting cell proliferation and preventing neural tube defects. However, in the post-fortification era, there has been a rising concern regarding an excess maternal intake of folic acid (FA), the synthetic form of folate. In this review, we focused on recent advancements in understanding the influence of excess maternal FA intake on offspring. For human studies, we summarized findings from clinical trials investigating the effects of periconceptional FA intake on neurodevelopment and molecular-level changes in offspring. For studies using mouse models, we compiled the impact of high maternal FA supplementation on gene expression and behavioral changes in offspring. In summary, excessive maternal folate intake could potentially have adverse effects on offspring. Overall, we highlighted concerns regarding elevated maternal folate status in the population, providing a comprehensive perspective on the potential adverse effects of excessive maternal FA supplementation on offspring.
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Affiliation(s)
- Xiguang Xu
- Epigenomics and Computational Biology Lab, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA 24061, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
| | - Ziyu Zhang
- Epigenomics and Computational Biology Lab, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA 24061, USA
- Department of Human Development and Family Science, College of Liberal Arts and Human Sciences, Virginia Tech, Blacksburg, VA 24061, USA
| | - Yu Lin
- Epigenomics and Computational Biology Lab, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA 24061, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
- Genetics, Bioinformatics and Computational Biology Program, Virginia Tech, Blacksburg, VA 24061, USA
| | - Hehuang Xie
- Epigenomics and Computational Biology Lab, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA 24061, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
- Genetics, Bioinformatics and Computational Biology Program, Virginia Tech, Blacksburg, VA 24061, USA
- Translational Biology, Medicine, and Health Program, Virginia Tech, Blacksburg, VA 24061, USA
- School of Neuroscience, Virginia Tech, Blacksburg, VA 24061, USA
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4
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Zhou Z, Wang M, Fan Q, Zhao Y, Wang N. The function of chemical folic acid in calibration methods and neurodevelopmental disorders. Front Chem 2024; 12:1355848. [PMID: 38456186 PMCID: PMC10917952 DOI: 10.3389/fchem.2024.1355848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Functional molecules have been attracting increasing attention in environmental and physiological studies. In particular, folic acid (FA) could be considered a key factor in estimating, adjusting, and making decisions in the treatment of neurodevelopmental disorders. It promotes the general significance and conceptual for considering FA molecular scientific research detections, which implies related advancement in both of biological structure and detection methods. Among these applications, the FA molecule acts as a coenzyme that incorporates carbon atoms and synthesizes purines and pyrimidines. Therefore, the calibration method has real applications and can be used as a sensing platform and for detection approaches, which conveys the internal relationship between the FA molecule and physiological characterization. This mini review briefly discusses multiple FA application fields and detection pathways and could supplement their utilization in anticipation of the onset of disease.
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Affiliation(s)
- Ziqi Zhou
- Department of Children Healthcare, Chongqing Health Center for Women and Children, Chongqing, China
| | - Meng Wang
- Child and Adolescent Department of Chongqing Mental Health Center, Chongqing, China
| | - Qiongli Fan
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Zhao
- Department of Children Healthcare, Chongqing Health Center for Women and Children, Chongqing, China
| | - Nianrong Wang
- Department of Children Healthcare, Chongqing Health Center for Women and Children, Chongqing, China
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5
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Kubant R, Cho CE, Pannia E, Hammoud R, Yang NV, Simonian R, Anderson GH. Methyl donor micronutrients, hypothalamic development and programming for metabolic disease. Neurosci Biobehav Rev 2024; 157:105512. [PMID: 38128771 DOI: 10.1016/j.neubiorev.2023.105512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/14/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
Nutriture in utero is essential for fetal brain development through the regulation of neural stem cell proliferation, differentiation, and apoptosis, and has a long-lasting impact on risk of disease in offspring. This review examines the role of maternal methyl donor micronutrients in neuronal development and programming of physiological functions of the hypothalamus, with a focus on later-life metabolic outcomes. Although evidence is mainly derived from preclinical studies, recent research shows that methyl donor micronutrients (e.g., folic acid and choline) are critical for neuronal development of energy homeostatic pathways and the programming of characteristics of the metabolic syndrome in mothers and their children. Both folic acid and choline are active in one-carbon metabolism with their impact on epigenetic modification of gene expression. We conclude that an imbalance of folic acid and choline intake during gestation disrupts DNA methylation patterns affecting mechanisms of hypothalamic development, and thus elevates metabolic disease risk. Further investigation, including studies to determine translatability to humans, is required.
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Affiliation(s)
- Ruslan Kubant
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Clara E Cho
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Emanuela Pannia
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Rola Hammoud
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Neil Victor Yang
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Rebecca Simonian
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - G Harvey Anderson
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada.
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6
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Fardous AM, Heydari AR. Uncovering the Hidden Dangers and Molecular Mechanisms of Excess Folate: A Narrative Review. Nutrients 2023; 15:4699. [PMID: 37960352 PMCID: PMC10648405 DOI: 10.3390/nu15214699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
This review delves into the intricate relationship between excess folate (vitamin B9) intake, especially its synthetic form, namely, folic acid, and its implications on health and disease. While folate plays a pivotal role in the one-carbon cycle, which is essential for DNA synthesis, repair, and methylation, concerns arise about its excessive intake. The literature underscores potential deleterious effects, such as an increased risk of carcinogenesis; disruption in DNA methylation; and impacts on embryogenesis, pregnancy outcomes, neurodevelopment, and disease risk. Notably, these consequences stretch beyond the immediate effects, potentially influencing future generations through epigenetic reprogramming. The molecular mechanisms underlying these effects were examined, including altered one-carbon metabolism, the accumulation of unmetabolized folic acid, vitamin-B12-dependent mechanisms, altered methylation patterns, and interactions with critical receptors and signaling pathways. Furthermore, differences in the effects and mechanisms mediated by folic acid compared with natural folate are highlighted. Given the widespread folic acid supplementation, it is imperative to further research its optimal intake levels and the molecular pathways impacted by its excessive intake, ensuring the health and well-being of the global population.
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Affiliation(s)
- Ali M. Fardous
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ahmad R. Heydari
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI 48202, USA
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7
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Irvine N, England-Mason G, Field CJ, Letourneau N, Bell RC, Giesbrecht GF, Kinniburgh DW, MacDonald AM, Martin JW, Dewey D. Associations between maternal folate status and choline intake during pregnancy and neurodevelopment at 3-4 years of age in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. J Dev Orig Health Dis 2023; 14:402-414. [PMID: 36939090 PMCID: PMC10202845 DOI: 10.1017/s2040174423000041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Folate and choline are methyl donor nutrients that may play a role in fetal brain development. Animal studies have reported that prenatal folate and choline supplementation are associated with better cognitive outcomes in offspring and that these nutrients may interact and affect brain development. Human studies that have investigated associations between maternal prenatal folate or choline levels and neurodevelopmental outcomes have reported contradictory findings and no human studies have examined the potential interactive effect of folate and choline on children's neurodevelopment. During the second trimester of pregnancy, maternal red blood cell folate was measured from blood samples and choline intake was estimated using a 24-h dietary recall in 309 women in the APrON cohort. At 3-5 years of age, their children's neurodevelopment was assessed using the Wechsler Preschool and Primary Scales of Intelligence - Fourth EditionCND, NEPSY-II language and memory subtests, four behavioral executive function tasks, and the Movement Assessment Battery for Children - Second Edition. Adjusted regressions revealed no associations between maternal folate and choline levels during pregnancy and most of the child outcomes. On the Dimensional Change Card Sort, an executive function task, there was an interaction effect; at high levels of choline intake (i.e., 1 SD above the mean; 223.03 mg/day), higher maternal folate status was associated with decreased odds of receiving a passing score (β = -0.44; 95%CI -0.81, -0.06). In conclusion, maternal folate status and choline intake during the second trimester of pregnancy were not associated with children's intelligence, language, memory, or motor outcomes at 3-4 years of age; however, their interaction may have an influence children's executive functions.
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Affiliation(s)
- Nathalie Irvine
- Bachelor of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gillian England-Mason
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nicole Letourneau
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - David W Kinniburgh
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Amy M MacDonald
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Sciences, Stockholm University, Stockholm, Sweden
| | - Deborah Dewey
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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8
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Maternal folic acid supplement use/dietary folate intake from preconception to early pregnancy and neurodevelopment in 2-year-old offspring: the Japan Environment and Children's Study. Br J Nutr 2022; 128:2480-2489. [PMID: 35115066 DOI: 10.1017/s000711452200037x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We evaluated the association between maternal prenatal folic acid supplementation/dietary folate intake and motor and cognitive development in 2-year-old offspring using data from the Japan Environment and Children's Study database. Neurodevelopment of 2-year-old offspring were evaluated using the Kyoto Scale of Psychological Development 2001. In total, data of 3839 offspring were analysed. For folic acid supplementation, a multiple regression analysis showed that offspring of mothers who started using folic acid supplements before conception had a significantly lower developmental quotient (DQ) in the postural-motor DQ area than offspring of mothers who did not use them at any time throughout their pregnancy (partial regression coefficient (B) -2·596, 95 % CI -4·738, -0·455). Regarding daily dietary folate intake from preconception to early pregnancy, a multiple regression analysis showed that the group with ≥ 200 µg had a significantly higher DQ in the language-social area than the group with <200 µg. The DQ was higher in the ≥ 400 µg group (B 2·532, 95 % CI 0·201, 4·863) than the 200 to <400 µg group (B 1·437, 95 % CI 0·215, 2·660). In conclusion, our study showed that maternal adequate dietary folate intake from preconception to early pregnancy has a beneficial association with verbal cognition development in 2-year-old offspring. On the other hand, mothers who started using folic acid supplements before conception had an inverse association with motor development in 2-year-old offspring. There were no details on the amount of folic acid in the supplements used and frequency of use. Therefore, further studies are required.
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9
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Compañ-Gabucio LM, Torres-Collado L, Garcia-de la Hera M, Fernández-Somoano A, Tardón A, Julvez J, Sunyer J, Rebagliato M, Murcia M, Ibarluzea J, Santa-Marina L, Vioque J. Association between the Use of Folic Acid Supplements during Pregnancy and Children's Cognitive Function at 7-9 Years of Age in the INMA Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12123. [PMID: 36231425 PMCID: PMC9566194 DOI: 10.3390/ijerph191912123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the association between maternal low (<400 μg/day) or high (≥1000 μg/day) folic acid supplements (FAs) use during pregnancy and the attentional function and working memory in boys and girls at age 7-9. A longitudinal analysis based on 1609 mother-child pairs from the Spanish Infancia y Medio Ambiente Project was carried out. Multivariable regression analyses revealed that, compared to the recommended FAs use, a low FAs use during the second period of pregnancy was associated with a lower alertness in all children (β = 18.70 ms; 95% CI: 7.51; 29.89) and in girls (β = 30.01 ms; 95% CI: 12.96; 47.01), and with a lower N-back Task performance in boys (d' number 2-back (β = -0.25; 95% CI: -0.49; 0.01)). A high FAs use throughout the two periods of pregnancy was associated with a better N-back Task performance only in girls (d' number 2-back (β = 0.28; 95% CI: 0.01; 0.56) and d' number 3-back (β = 0.32; 95% CI: 0.08; 0.56)). The maternal use of FAs beyond the periconceptional period may affect children's attentional function and working memory at age 7-9 differently for boys and girls.
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Affiliation(s)
- Laura María Compañ-Gabucio
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Laura Torres-Collado
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Manuela Garcia-de la Hera
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Ana Fernández-Somoano
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Departamento de Medicina, Universidad de Oviedo, 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue s/n, 33001 Oviedo, Spain
| | - Adonina Tardón
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Departamento de Medicina, Universidad de Oviedo, 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue s/n, 33001 Oviedo, Spain
| | - Jordi Julvez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
- ISGlobal, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Jordi Sunyer
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
- ISGlobal, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Marisa Rebagliato
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), FISABIO—Public Health, FISABIO—Universitat Jaume I-Universitat de València, 46015 Valencia, Spain
- Department of Medicine, Universitat Jaume I, 12071 Castellon de la Plana, Spain
| | - Mario Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), FISABIO—Public Health, FISABIO—Universitat Jaume I-Universitat de València, 46015 Valencia, Spain
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana, 46010 Valencia, Spain
| | - Jesús Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Group of Environmental Epidemiology, Biodonostia Health Research Institute, 20014 Donostia-San Sebastian, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 Donostia-San Sebastian, Spain
- School of Psychology, University of the Basque Country UPV/EHU, 20018 Donostia-San Sebastian, Spain
| | - Loreto Santa-Marina
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Group of Environmental Epidemiology, Biodonostia Health Research Institute, 20014 Donostia-San Sebastian, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 Donostia-San Sebastian, Spain
| | - Jesús Vioque
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
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10
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The Impact of Maternal Folates on Brain Development and Function after Birth. Metabolites 2022; 12:metabo12090876. [PMID: 36144280 PMCID: PMC9503684 DOI: 10.3390/metabo12090876] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/28/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Folate is vital for biological processes within the body, including DNA synthesis, DNA repair, and methylation reactions that metabolize homocysteine. The role of folate is particularly important in pregnancy, where there is rapid cellular and tissue growth. Maternal folate deficiencies secondary to inadequate dietary supplementation are known to produce defects in the neural tube and spinal cord, yet the exact mechanism of folate in neurodevelopment is unknown. The consequences of maternal folate deficiency on offspring brain development and function beyond gestation are not well defined. The objective of this review is to investigate the role of folate deficiency in offspring neurodevelopment, and the complications that arise post-gestation. This was accomplished through a comprehensive review of the data presented in both clinical and preclinical studies. Evidence supports that folate deficiency is associated with altered offspring neurodevelopment, including smaller total brain volume, altered cortical thickness and cerebral white matter, altered neurogenesis, and neuronal apoptosis. Some of these changes have been associated with altered brain function in offspring with memory, motor function, language skills, and psychological issues. This review of literature also presents potential mechanisms of folate deficiency in neurodevelopment with altered metabolism, neuroinflammation, epigenetic modification through DNA methylation, and a genetic deficiency in one-carbon metabolism.
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11
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Ondičová M, Irwin RE, Thursby SJ, Hilman L, Caffrey A, Cassidy T, McLaughlin M, Lees-Murdock DJ, Ward M, Murphy M, Lamers Y, Pentieva K, McNulty H, Walsh CP. Folic acid intervention during pregnancy alters DNA methylation, affecting neural target genes through two distinct mechanisms. Clin Epigenetics 2022; 14:63. [PMID: 35578268 PMCID: PMC9112484 DOI: 10.1186/s13148-022-01282-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/29/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We previously showed that continued folic acid (FA) supplementation beyond the first trimester of pregnancy appears to have beneficial effects on neurocognitive performance in children followed for up to 11 years, but the biological mechanism for this effect has remained unclear. Using samples from our randomized controlled trial of folic acid supplementation in second and third trimester (FASSTT), where significant improvements in cognitive and psychosocial performance were demonstrated in children from mothers supplemented in pregnancy with 400 µg/day FA compared with placebo, we examined methylation patterns from cord blood (CB) using the EPIC array which covers approximately 850,000 cytosine-guanine (CG) sites across the genome. Genes showing significant differences were verified using pyrosequencing and mechanistic approaches used in vitro to determine effects on transcription. RESULTS FA supplementation resulted in significant differences in methylation, particularly at brain-related genes. Further analysis showed these genes split into two groups. In one group, which included the CES1 gene, methylation changes at the promoters were important for regulating transcription. We also identified a second group which had a characteristic bimodal profile, with low promoter and high gene body (GB) methylation. In the latter, loss of methylation in the GB is linked to decreases in transcription: this group included the PRKAR1B/HEATR2 genes and the dopamine receptor regulator PDE4C. Overall, methylation in CB also showed good correlation with methylation profiles seen in a published data set of late gestation foetal brain samples. CONCLUSION We show here clear alterations in DNA methylation at specific classes of neurodevelopmental genes in the same cohort of children, born to FA-supplemented mothers, who previously showed improved cognitive and psychosocial performance. Our results show measurable differences at neural genes which are important for transcriptional regulation and add to the supporting evidence for continued FA supplementation throughout later gestation. This trial was registered on 15 May 2013 at www.isrctn.com as ISRCTN19917787.
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Affiliation(s)
- Miroslava Ondičová
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK
| | - Rachelle E Irwin
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK
| | - Sara-Jayne Thursby
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Luke Hilman
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK
| | - Aoife Caffrey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Tony Cassidy
- Psychology Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - Marian McLaughlin
- Psychology Institute, Ulster University, Coleraine, Northern Ireland, UK
| | - Diane J Lees-Murdock
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Michelle Murphy
- Unitat de Medicina Preventiva i Salut Pública, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Yvonne Lamers
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, and British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Colum P Walsh
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, UK.
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
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12
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Irvine N, England-Mason G, Field CJ, Dewey D, Aghajafari F. Prenatal Folate and Choline Levels and Brain and Cognitive Development in Children: A Critical Narrative Review. Nutrients 2022; 14:nu14020364. [PMID: 35057545 PMCID: PMC8778665 DOI: 10.3390/nu14020364] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/13/2023] Open
Abstract
Women’s nutritional status during pregnancy can have long-term effects on children’s brains and cognitive development. Folate and choline are methyl-donor nutrients and are important for closure of the neural tube during fetal development. They have also been associated with brain and cognitive development in children. Animal studies have observed that prenatal folate and choline supplementation is associated with better cognitive outcomes in offspring and that these nutrients may have interactive effects on brain development. Although some human studies have reported associations between maternal folate and choline levels and child cognitive outcomes, results are not consistent, and no human studies have investigated the potential interactive effects of folate and choline. This lack of consistency could be due to differences in the methods used to assess folate and choline levels, the gestational trimester at which they were measured, and lack of consideration of potential confounding variables. This narrative review discusses and critically reviews current research examining the associations between maternal levels of folate and choline during pregnancy and brain and cognitive development in children. Directions for future research that will increase our understanding of the effects of these nutrients on children’s neurodevelopment are discussed.
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Affiliation(s)
- Nathalie Irvine
- O’Brien Centre for the Bachelor of Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada;
| | - Gillian England-Mason
- Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (G.E.-M.); (D.D.)
- Department of Pediatrics, Cumming School of Medicine, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-126C Li Ka Shing Centre for Research, 11203-87th Ave NW, Edmonton, AB T6G 2H5, Canada;
| | - Deborah Dewey
- Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (G.E.-M.); (D.D.)
- Department of Pediatrics, Cumming School of Medicine, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
- Hotchkiss Brain Institute, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, G012, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Correspondence:
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13
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Craig JJ, Scott S, Leach JP. Epilepsy and pregnancy: identifying risks. Pract Neurol 2021; 22:98-106. [PMID: 34887343 DOI: 10.1136/practneurol-2019-002304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/04/2022]
Abstract
Pregnancy is a time of physical, physiological and psychological challenge. For women with epilepsy, as well as its potential for joy and fulfilment, pregnancy may bring additional risks and difficulties. Clinicians must anticipate and prevent these complications, ensuring that pregnancy, delivery and motherhood proceed without obstetric or medical complications, using available evidence to balance individual risks of undertreatment and overtreatment. Here we review epilepsy management in pregnancy, identifying some of the known effects of epilepsy and its treatment on gestation, fetal malformation, delivery, and neurocognitive and behavioural development. We outline strategies to reduce obstetric and fetal complications in women with epilepsy, while recognising the sometimes competing need to maintain or improve seizure control. We reinforce the importance of identifying those at highest risk, who may require additional measures or safeguards.
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Affiliation(s)
- John J Craig
- Neurology, Belfast Health and Social Care Trust, Belfast, UK
| | - Shona Scott
- Department of Clinical Neurosciences, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
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14
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Chen H, Qin L, Gao R, Jin X, Cheng K, Zhang S, Hu X, Xu W, Wang H. Neurodevelopmental effects of maternal folic acid supplementation: a systematic review and meta-analysis. Crit Rev Food Sci Nutr 2021:1-17. [PMID: 34672229 DOI: 10.1080/10408398.2021.1993781] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Folic acid, a water-soluble vitamin B nutrient, plays an important role not only in maintaining a healthy pregnancy but also in offspring brain development and function, however, it remains unclear whether maternal folic acid (FA) supplementation associated with the risk of different postnatal neurodevelopmental outcomes. Here, we performed a systematic review and meta-analysis on the impact of maternal FA supplementation on a wide range of postnatal neurodevelopmental outcomes which include intellectual development, risk of autistic traits, ADHD, behavior, language, and psychomotor problems, using studies extracted from the following databases, including MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, and PsychInfo. Thirty-two cohort studies and seven case-control studies were included in this meta-analysis. In the present study, we found that prenatal FA supplementation had a positive impact on offspring's neurodevelopmental outcomes, including improved intellectual development and reduced risk of autism traits, ADHD, behavioral, and language problems. We also found that FA over-supplementation was not associated with an improvement in offspring's brain development, and may have a negative impact on offspring's neurodevelopmental outcomes. This study proved the first panoramic review on the relationship of FA supplementation with offspring's neurodevelopment. Further studies focusing on different dosages and periods of FA supplementation are needed.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1993781 .
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Affiliation(s)
- Hanxiao Chen
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lang Qin
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rui Gao
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaolei Jin
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Kemin Cheng
- Outpatient Department, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Sirui Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiao Hu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenming Xu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,SCU-CUHK Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hongjing Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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15
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Korsmo HW, Jiang X. One carbon metabolism and early development: a diet-dependent destiny. Trends Endocrinol Metab 2021; 32:579-593. [PMID: 34210607 PMCID: PMC8282711 DOI: 10.1016/j.tem.2021.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022]
Abstract
One carbon metabolism (OCM) is critical for early development, as it provides one carbon (1C) units for the biosynthesis of DNA, proteins, and lipids and epigenetic modification of the genome. Epigenetic marks established early in life can be maintained and exert lasting impacts on gene expression and functions later in life. Animal and human studies have increasingly demonstrated that prenatal 1C nutrient deficiencies impair fetal growth, neurodevelopment, and cardiometabolic parameters in childhood, while sufficient maternal 1C nutrient intake is protective against these detrimental outcomes. However, recent studies also highlight the potential risk of maternal 1C nutrient excess or imbalance in disrupting early development. Further studies are needed to delineate the dose-response relationship among prenatal 1C nutrient exposure, epigenetic modifications, and developmental outcomes.
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Affiliation(s)
- Hunter W Korsmo
- PhD Program in Biochemistry, The Graduate Center CUNY (City University of New York), New York, NY 10016, USA; Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA
| | - Xinyin Jiang
- PhD Program in Biochemistry, The Graduate Center CUNY (City University of New York), New York, NY 10016, USA; Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA.
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16
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Sadat-Hossieny Z, Robalino CP, Pennell PB, Cohen MJ, Loring DW, May RC, Block T, Swiatlo T, Meador KJ. Folate fortification of food: Insufficient for women with epilepsy. Epilepsy Behav 2021; 117:107688. [PMID: 33636531 PMCID: PMC8684790 DOI: 10.1016/j.yebeh.2020.107688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Folic acid supplementation during the periconceptual period has been shown to improve cognitive outcomes in children of women with epilepsy taking anti-seizure medications (ASMs). The dose of folic acid necessary to provide positive cognitive outcomes is unclear. In many countries including the United States, food is fortified with folic acid, but no data exist on how food fortification may affect cognition in children with fetal-ASM exposure. This study evaluated the effect of dietary folate from natural folates plus folic acid fortification, separate from folic acid vitamin supplements, on age-6 year IQ in children with fetal-ASM exposure. METHODS Data from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study were retrospectively analyzed for this investigation. Assessment of nutrient intake was conducted using the Block Food Frequency Questionnaire-98. The primary outcome of the present study was to assess association of maternal prepregnancy nutrient levels to child age-6 IQ. RESULTS Folate from food alone without supplement was not associated with improvement of age-6 IQ in children with fetal ASM exposure (95% CI: -11.7-2.3, p = 0.187). Periconceptual folate supplement use was associated with a 10.1-point higher age-6 IQ (95% CI: 5.2-15.0, p < .001). Total combined folate from food plus supplement also showed that higher intake of folate was associated with higher age-6 IQ (Coefficient: 4.5, 95% CI: 2.0-6.9, p < .001). Six other nutrients from food and supplements were analyzed (Vitamin C, Vitamin D, Vitamin E, Omega 3, Gamma Tocopherol, and Vitamin B12) and had no significant association with age 6-IQ. SIGNIFICANCE Dietary content of folate, even in a country where food is fortified with folic acid, is not sufficient to provide improved cognitive outcomes for children of women taking ASMs during pregnancy. Folate supplementation is needed for significant improvement in cognitive outcomes, specifically age-6 IQ.
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Affiliation(s)
- Zahra Sadat-Hossieny
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | | | - Page B. Pennell
- Department of Neurology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - David W. Loring
- Departments of Neurology and Pediatrics, Emory University, Atlanta, GA, USA
| | | | | | - Travis Swiatlo
- Department of Clinical Nutrition, Stanford Hospitals and Clinics, Stanford, CA, USA
| | - Kimford J. Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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17
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Risk of early neurodevelopmental disorders associated with in utero exposure to valproate and other antiepileptic drugs: a nationwide cohort study in France. Sci Rep 2020; 10:17362. [PMID: 33093466 PMCID: PMC7581762 DOI: 10.1038/s41598-020-74409-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Information available on the risks of neurodevelopmental disorders (NDs) associated with in utero exposure to valproate (VPA) and to other antiepileptic drugs (AEDs) is limited. A nationwide population-based cohort study was conducted based on comprehensive data of the French National Health Data System (SNDS). Liveborn infants without brain malformation, born between January 2011 and December 2014, were followed from birth up to December 2016. NDs were identified based on diagnoses of mental or behavioural disorders and utilization of speech therapy, orthoptic or psychiatric services. The risk of NDs was compared between children exposed in utero to AED monotherapy and unexposed children, using Cox proportional hazard models adjusted for maternal and neonatal characteristics. The cohort included 1,721,990 children, 8848 of whom were exposed in utero to AED monotherapy. During a mean follow-up of 3.6 years, 15,458 children had a diagnosis of mental or behavioural disorder. In utero exposure to VPA was associated with an increased risk of NDs overall (aHR: 3.7; 95% CI 2.8–4.9) and among children born to a mother without mental illness (aHR 5.1; 95% CI 3.6–7.3). A dose–response relationship was demonstrated and the risk of NDs was more particularly increased for an exposure to VPA during the second or third trimesters of pregnancy. Among the other AEDs, only pregabalin was consistently associated with an increased risk of NDs (aHR: 1.5; 95% CI 1.0–2.1). This study confirms a four to fivefold increased risk of early NDs associated with exposure to VPA during pregnancy. The risk associated with other AEDs appears much lower.
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18
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Nilsen FM, Ruiz JD, Tulve NS. A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155451. [PMID: 32751096 PMCID: PMC7432904 DOI: 10.3390/ijerph17155451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
General cognitive ability, often referred to as ‘general intelligence’, comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother’s ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child’s total environment and early cognitive development.
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Affiliation(s)
- Frances M. Nilsen
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Correspondence: ; Tel.: +1-919-541-2574
| | - Jazmin D.C. Ruiz
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Honeywell International, Buffalo, NY 14210, USA
| | - Nicolle S. Tulve
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
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19
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Saxena R, Babadi M, Namvarhaghighi H, Roullet FI. Role of environmental factors and epigenetics in autism spectrum disorders. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 173:35-60. [PMID: 32711816 DOI: 10.1016/bs.pmbts.2020.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder thought to be caused by predisposing high-risk genes that may be altered during the early development by environmental factors. The impact of maternal challenges during pregnancy on the prevalence of ASD has been widely studied in clinical and animal studies. Here, we review some clinical and pre-clinical evidence that links environmental factors (i.e., infection, air pollution, pesticides, valproic acid and folic acid) and the risk of ASD. Additionally, certain prenatal environmental challenges such as the valproate and folate prenatal exposures allow us to study mechanisms possibly linked to the etiology of ASD, for instance the epigenetic processes. These mechanistic pathways are also presented and discussed in this chapter.
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Affiliation(s)
- Roheeni Saxena
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Melika Babadi
- School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | | | - Florence I Roullet
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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20
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Maternal folate levels during pregnancy and children's neuropsychological development at 2 years of age. Eur J Clin Nutr 2020; 74:1585-1593. [PMID: 32242139 DOI: 10.1038/s41430-020-0612-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore the relationship between maternal folate levels during pregnancy and children's neuropsychological development at 2 years of age. METHODS In the birth cohort MKFOAD, maternal serum folate concentrations at 12-14, 22-26, and 34-36 weeks of gestation were measured, as well as red blood cell (RBC) folate at 12-14 weeks. Neurodevelopment of 2-year-old children was assessed by Gesell Development Scale (GDS), which contained subscales of gross motor, fine motor, language, adaptive behavior, and social behavior. Linear regression models were applied to investigate the association of maternal folate levels with children's developmental quotients (DQs). RESULTS One hundred and eighty singleton children participated the GDS assessment, of whom 97 (53.9%) were boys. Median RBC folate concentration was 1002.8 (IQR = 577.6) nmol L-1 in early pregnancy and median serum folate concentrations were, respectively, 33.9 (IQR = 9.2) nmol L-1, 26.3 (IQR = 14.3) nmol L-1, and 26.7 (IQR = 18.9) nmol L-1. Maternal serum folate concentration in late pregnancy was significantly associated with children's language development, where language DQ increases by 3.1 (95% CI 0.6, 5.5) for every 10 nmol L-1 increment of serum folate concentration. And maternal serum folate in early pregnancy was significantly associated with children's fine motor development, with 2.0 (95% CI 0.1, 4.0) DQ decrease for 10 nmol L-1 increase of serum folate. CONCLUSIONS Maternal serum folate in late pregnancy was significantly associated with children's language development at age 2, which supports the importance of remaining folic acid supplementation across the entire gestation. However, maternal serum folate in early pregnancy was also inversely associated with children's fine motor development.
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21
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Gatica-Domínguez G, Rothenberg SJ, Torres-Sánchez L, Schnaas L, Stein AD, Schmidt RJ, López-Carrillo L. The association of prenatal folate and vitamin B12 levels with postnatal neurodevelopment varies by maternal MTHFR 677C>T genotype. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2020. [DOI: 10.1177/0165025419853379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prenatal folate and vitamin B12 status have been linked to child neuropsychological development, but less is known about maternal genetic influences on this association. We conducted an exploratory longitudinal study of 181 mother–child pairs to assess whether maternal MTHFR 677C>T genotype modifies the association between maternal plasma folate and vitamin B12 in the first trimester of pregnancy and child neuropsychological development. Maternal plasma folate and vitamin B12 were determined by radioimmunoassay, and MTHFR 677C>T genotypes by PCR. We evaluated child neuropsychological development at 1, 3, 6, 12, 18, 24, and 30 month old using the Bayley Scales of Infant Development II. We analyzed the data using mixed-effects multivariate linear regression. The MTHFR 677C>T genotype distribution among the mothers was 18.2% CC, 49.8% CT, and 32.0% TT. The Mental Development Index (MDI) was inversely associated with maternal plasma folate among offspring of MTHFR 677CC mothers (β = -2.18 per twofold increase, 95% CI -4.07; -0.30, corrected P value = 0.02); no significant associations were observed among children born to women of other genotypes. The Motor Development Index (PDI) was not significantly associated with maternal plasma folate in any maternal MTHFR 677C>T genotype group, nor were MDI or PDI significantly associated with maternal plasma vitamin B12 in any maternal MTHFR 677C>T genotype group. This study suggests that maternal MTHFR 677CC genotype interacts with first-trimester plasma folate to influence offspring mental development.
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Affiliation(s)
| | | | | | - Lourdes Schnaas
- Subdirección de Investigación en Intervenciones Comunitarias, Instituto Nacional de Perinatología, Mexico
| | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, USA
| | - Rebecca J. Schmidt
- Department of Public Health Science and the MIND Institute, University of California Davis School of Medicine, USA
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Meador KJ, Pennell PB, May RC, Brown CA, Baker G, Bromley R, Loring DW, Cohen MJ. Effects of periconceptional folate on cognition in children of women with epilepsy: NEAD study. Neurology 2019; 94:e729-e740. [PMID: 31871217 DOI: 10.1212/wnl.0000000000008757] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/21/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests potential positive neuropsychological effects of periconceptional folate in both healthy children and children exposed in utero to antiseizure medications (ASMs). In this report, we test the hypothesis that periconceptional folate improves neurodevelopment in children of women with epilepsy by re-examining data from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study. METHODS The NEAD study was an NIH-funded, prospective, observational, multicenter investigation of pregnancy outcomes in 311 children of 305 women with epilepsy treated with ASM monotherapy. Missing data points were imputed with Markov chain Monte Carlo methods. Multivariate analyses adjusted for multiple factors (e.g., maternal IQ, ASM type, standardized ASM dose, and gestational birth age) were performed to assess the effects of periconceptional folate on cognitive outcomes (i.e., Full Scale Intelligence Quotient [FSIQ], Verbal and Nonverbal indexes, and Expressive and Receptive Language indexes at 3 and 6 years of age, and executive function and memory function at 6 years of age). RESULTS Periconceptional folate was associated with higher FSIQ at both 3 and 6 years of age. Significant effects for other measures included Nonverbal Index, Expressive Language Index, and Developmental Neuropsychological Assessment Executive Function at 6 years of age, and Verbal Index and Receptive Language Index at 3 years of age. Nonsignificant effects included Verbal Index, Receptive Index, Behavior Rating Inventory of Executive Function-Parent Questionnaire Executive Function, and General Memory Index at 6 years of age, and Nonverbal Index and Expressive Index at 3 years of age. CONCLUSIONS Use of periconceptional folate in pregnant women with epilepsy taking ASMs is associated with better cognitive development. CLINICALTRIALSGOV IDENTIFIER NCT00021866.
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Affiliation(s)
- Kimford J Meador
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA.
| | - Page B Pennell
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Ryan C May
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Carrie A Brown
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Gus Baker
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Rebecca Bromley
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - David W Loring
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Morris J Cohen
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
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McNulty H, Rollins M, Cassidy T, Caffrey A, Marshall B, Dornan J, McLaughlin M, McNulty BA, Ward M, Strain JJ, Molloy AM, Lees-Murdock DJ, Walsh CP, Pentieva K. Effect of continued folic acid supplementation beyond the first trimester of pregnancy on cognitive performance in the child: a follow-up study from a randomized controlled trial (FASSTT Offspring Trial). BMC Med 2019; 17:196. [PMID: 31672132 PMCID: PMC6823954 DOI: 10.1186/s12916-019-1432-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Periconceptional folic acid prevents neural tube defects (NTDs), but it is uncertain whether there are benefits for offspring neurodevelopment arising from continued maternal folic acid supplementation beyond the first trimester. We investigated the effect of folic acid supplementation during trimesters 2 and 3 of pregnancy on cognitive performance in the child. METHODS We followed up the children of mothers who had participated in a randomized controlled trial in 2006/2007 of Folic Acid Supplementation during the Second and Third Trimesters (FASSTT) and received 400 μg/d folic acid or placebo from the 14th gestational week until the end of pregnancy. Cognitive performance of children at 7 years was evaluated using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and at 3 years using the Bayley's Scale of Infant and Toddler Development (BSITD-III). RESULTS From a total of 119 potential mother-child pairs, 70 children completed the assessment at age 7 years, and 39 at age 3 years. At 7 years, the children of folic acid treated mothers scored significantly higher than the placebo group in word reasoning: mean 13.3 (95% CI 12.4-14.2) versus 11.9 (95% CI 11.0-12.8); p = 0.027; at 3 years, they scored significantly higher in cognition: 10.3 (95% CI 9.3-11.3) versus 9.5 (95% CI 8.8-10.2); p = 0.040. At both time points, greater proportions of children from folic acid treated mothers compared with placebo had cognitive scores above the median values of 10 (girls and boys) for the BSITD-III, and 24.5 (girls) and 21.5 (boys) for the WPPSI-III tests. When compared with a nationally representative sample of British children at 7 years, WPPSI-III test scores were higher in children from folic acid treated mothers for verbal IQ (p < 0.001), performance IQ (p = 0.035), general language (p = 0.002), and full scale IQ (p = 0.001), whereas comparison of the placebo group with British children showed smaller differences in scores for verbal IQ (p = 0.034) and full scale IQ (p = 0.017) and no differences for performance IQ or general language. CONCLUSIONS Continued folic acid supplementation in pregnancy beyond the early period recommended to prevent NTD may have beneficial effects on child cognitive development. Further randomized trials in pregnancy with follow-up in childhood are warranted. TRIAL REGISTRATION ISRCTN ISRCTN19917787 . Registered 15 May 2013.
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Affiliation(s)
- Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, Northern Ireland, UK
| | - Mark Rollins
- Northern Health and Social Care Trust, Causeway Hospital, Northern Ireland, UK
| | - Tony Cassidy
- Psychology Research Institute, Ulster University, Northern Ireland, UK
| | - Aoife Caffrey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, Northern Ireland, UK
| | - Barry Marshall
- Northern Health and Social Care Trust, Causeway Hospital, Northern Ireland, UK
| | - James Dornan
- Royal-Jubilee Maternity Service, Belfast, Northern Ireland, UK
| | - Marian McLaughlin
- Psychology Research Institute, Ulster University, Northern Ireland, UK
| | - Breige A McNulty
- Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, Northern Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, Northern Ireland, UK
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Diane J Lees-Murdock
- Genomic Medicine Group, School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Colum P Walsh
- Genomic Medicine Group, School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, BT52 1SA, Northern Ireland, UK.
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D'Souza S, Crawford CN, Buckley J, Underwood L, Peterson ER, Bird A, Morton SMB, Waldie KE. Antenatal determinants of early childhood talking delay and behavioural difficulties. Infant Behav Dev 2019; 57:101388. [PMID: 31634704 DOI: 10.1016/j.infbeh.2019.101388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/26/2022]
Abstract
The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | | | - Jude Buckley
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, NSW, Australia
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
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25
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McKee SE, Reyes TM. Effect of supplementation with methyl-donor nutrients on neurodevelopment and cognition: considerations for future research. Nutr Rev 2019; 76:497-511. [PMID: 29701796 DOI: 10.1093/nutrit/nuy007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pregnancy represents a critical period in fetal development, such that the prenatal environment can, in part, establish a lifelong trajectory of health or disease for the offspring. Poor nutrition (macro- or micronutrient deficiencies) can adversely affect brain development and significantly increase offspring risk for metabolic and neurological disease development. The concentration of dietary methyl-donor nutrients is known to alter DNA methylation in the brain, and alterations in DNA methylation can have long-lasting effects on gene expression and neuronal function. The decreased availability of methyl-donor nutrients to the developing fetus in models of poor maternal nutrition is one mechanism hypothesized to link maternal malnutrition and disease risk in offspring. Animal studies indicate that supplementation of both maternal and postnatal (early- and later-life) diets with methyl-donor nutrients can attenuate disease risk in offspring; however, clinical research is more equivocal. The objective of this review is to summarize how specific methyl-donor nutrient deficiencies and excesses during pre- and postnatal life alter neurodevelopment and cognition. Emphasis is placed on reviewing the current literature, highlighting challenges within nutrient supplementation research, and considering potential strategies to ensure robust findings in future studies.
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Affiliation(s)
- Sarah E McKee
- Department of Pharmacology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Teresa M Reyes
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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26
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Meador KJ. Periconceptional Folate Supplementation and the Risk of Autism Following Antiepileptic Drug Exposure. JAMA Neurol 2019; 75:151-152. [PMID: 29279883 DOI: 10.1001/jamaneurol.2017.3067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California
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Effects of maternal folic acid supplementation during pregnancy on infant neurodevelopment at 1 month of age: a birth cohort study in China. Eur J Nutr 2019; 59:1345-1356. [PMID: 31098661 DOI: 10.1007/s00394-019-01986-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/03/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aimed to explore effects of maternal folic acid (FA) supplementation during pregnancy on neurodevelopment in 1-month-old infants and to determine whether effects may be related to maternal circulating inflammatory cytokine concentrations. METHODS This birth cohort study recruited 1186 mother-infant pairs in Tianjin, China, between July 2015 and July 2017. The women completed interviewer-administered questionnaires on their lifestyles and FA supplementation during pregnancy. Neurodevelopment was assessed in 1-month-old infants using a standard neuropsychological examination table. In 192 women, serum homocysteine (Hcy) and inflammatory cytokine concentrations were measured at 16-18 weeks of gestation. RESULTS The infants whose mothers took FA supplements during pregnancy had a significantly higher development quotient (DQ) compared with those whose mothers were non-users (P < 0.05). After adjustment for maternal characteristics, supplementary FA use for 1-3 months, 3-6 months, and > 6 months were associated with the increases of 7.7, 11.0, and 7.4 units in the scale of infant DQ score compared with women reporting no supplement use, respectively (P < 0.05). FA supplementation was associated with a decreased serum concentration of Hcy (β = [Formula: see text] 0.19), which was correlated with women's serum inflammatory cytokine concentrations at 16-18 weeks of gestation (β = 0.57). Serum inflammatory cytokine concentrations were inversely related to DQ score in the 1-months-old offspring (β = [Formula: see text] 0.22). CONCLUSIONS Maternal FA supplementation during pregnancy favors neurodevelopment in the offspring at 1-month-old. This association may be mediated by changes in serum Hcy and inflammatory cytokine concentrations throughout pregnancy.
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Naninck EFG, Stijger PC, Brouwer-Brolsma EM. The Importance of Maternal Folate Status for Brain Development and Function of Offspring. Adv Nutr 2019; 10:502-519. [PMID: 31093652 PMCID: PMC6520042 DOI: 10.1093/advances/nmy120] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/18/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
The importance of an adequate periconceptional maternal folate status to prevent fetal neural tube defects has been well demonstrated and resulted in the recommendation for women to use folic acid supplements during the periconception period. The importance of maternal folate status for offspring neurodevelopment and brain health is less well described. We reviewed the current evidence linking maternal folate status before conception and during pregnancy with neurodevelopment and cognition of the offspring. We discuss both animal and human studies. Preclinical research revealed the importance of maternal folate status for several key processes required for normal neurodevelopment and brain functioning in the offspring, including DNA synthesis, regulation of gene expression, synthesis of phospholipids and neurotransmitters, and maintenance of healthy plasma homocysteine concentrations. Human observational studies are inconclusive; about half have shown a positive association between maternal folate status and cognitive performance of offspring. Whereas some studies suggest a positive association between maternal folate intake and cognition of offspring during childhood, data from interventional studies are too limited to conclude that there is a direct effect. Future preclinical studies are needed to help us characterize the behavioral effects, understand the underlying mechanisms, and to establish an optimal dosage and time window of folate supplementation. Moreover, more conclusive data from well-designed human observational studies and randomized controlled trials are needed to determine whether current recommendations for folic acid supplementation during pregnancy cover the needs for normal cognitive development in the offspring.
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Affiliation(s)
- Eva F G Naninck
- Swammerdam Institute for Life Sciences, Center for Neuroscience, Brain plasticity group, University of Amsterdam, Amsterdam, Netherlands
| | - Pascalle C Stijger
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands,Address correspondence to EMB-B (e-mail: )
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29
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Iglesias Vázquez L, Canals J, Arija V. Review and meta-analysis found that prenatal folic acid was associated with a 58% reduction in autism but had no effect on mental and motor development. Acta Paediatr 2019; 108:600-610. [PMID: 30466185 DOI: 10.1111/apa.14657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/29/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
AIM The impact of prenatal folic acid on children's neurodevelopment and the risk of autism spectrum disorder (ASD) remain unclear and this review and meta-analysis aimed to quantify any associations. METHODS We systematically searched PubMed, Scopus and The Cochrane Library until June 2018 with no language restrictions. Standardised mean differences and odds ratio with 95% confidence intervals are used to describe any associations between folic acid and mental development, motor development and ASD. RESULTS The search strategy identified 647 papers and 16 were finally included in the meta-analysis after the application of the exclusion criteria. These provided a total cohort size of 756 365 children aged 11 months to 15 years from 10 countries. The main finding was that prenatal use of folic acid was associated with a 58% reduction in the risk of ASD in children. We were surprised that better scores for mental development were associated with low prenatal exposure to folic acid. CONCLUSION Although the results should be interpreted with caution, they showed that routine prenatal supplements of folic acid were associated with significantly lower levels of ASD. Further studies are needed to reach a firm conclusion, given the multifactorial aetiology of neurodevelopment.
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Affiliation(s)
- Lucía Iglesias Vázquez
- Department of Preventive Medicine and Public Health Faculty of Medicine and Health Science Universitat Rovira i Virgili Reus Spain
| | - Josefa Canals
- Centre de Recerca en Avaluació I Mesura de la Conducta (CRAMC) Department of Psychology Universitat Rovira i Virgili Tarragona Spain
| | - Victoria Arija
- Department of Preventive Medicine and Public Health Faculty of Medicine and Health Science Universitat Rovira i Virgili Reus Spain
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30
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Abstract
Periconceptional folic acid (FA) is known to have a protective effect in the prevention of neural tube defects (NTD), leading to global recommendations for FA supplementation before and in early pregnancy. Maternal folate throughout pregnancy may have other roles in offspring health, including neurodevelopment and cognitive performance in childhood. Folate is essential for C1 metabolism, a network of pathways involved in several biological processes including nucleotide synthesis, DNA repair and methylation reactions. The evidence reviewed here shows a conclusive role for offspring health of maternal folate nutrition in early pregnancy and probable benefits in later pregnancy. Folate-mediated epigenetic changes in genes related to brain development and function offer a plausible biological basis to link maternal folate with effects in offspring brain, albeit this research is in its infancy. Mandatory FA fortification of food has proven to be highly effective in decreasing NTD cases in populations where it has been implemented, but this policy is controversial owing to concerns related to potential adverse effects of over-exposure to FA. In the absence of population-wide fortification, and given the generally poor compliance with current FA recommendations, optimising folate status of mothers in very early pregnancy for protection against NTD remains challenging. Thus, current policy in the UK, Ireland and elsewhere in Europe for the prevention of NTD (based on periconceptional FA supplementation only), has proven to be largely ineffective. This review addresses the evidence and the controversies that surround this area, as well as identifying the challenges in translating policy into practice.
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31
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Carlson AL, Xia K, Azcarate-Peril MA, Goldman BD, Ahn M, Styner MA, Thompson AL, Geng X, Gilmore JH, Knickmeyer RC. Infant Gut Microbiome Associated With Cognitive Development. Biol Psychiatry 2018; 83:148-159. [PMID: 28793975 PMCID: PMC5724966 DOI: 10.1016/j.biopsych.2017.06.021] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies in rodents provide compelling evidence that microorganisms inhabiting the gut influence neurodevelopment. In particular, experimental manipulations that alter intestinal microbiota impact exploratory and communicative behaviors and cognitive performance. In humans, the first years of life are a dynamic time in gut colonization and brain development, but little is known about the relationship between these two processes. METHODS We tested whether microbial composition at 1 year of age is associated with cognitive outcomes using the Mullen Scales of Early Learning and with global and regional brain volumes using structural magnetic resonance imaging at 1 and 2 years of age. Fecal samples were collected from 89 typically developing 1-year-olds. 16S ribosomal RNA amplicon sequencing was used for identification and relative quantification of bacterial taxa. RESULTS Cluster analysis identified 3 groups of infants defined by their bacterial composition. Mullen scores at 2 years of age differed significantly between clusters. In addition, higher alpha diversity was associated with lower scores on the overall composite score, visual reception scale, and expressive language scale at 2 years of age. Exploratory analyses of neuroimaging data suggest the gut microbiome has minimal effects on regional brain volumes at 1 and 2 years of age. CONCLUSIONS This is the first study to demonstrate associations between the gut microbiota and cognition in human infants. As such, it represents an essential first step in translating animal data into the clinic.
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Affiliation(s)
- Alexander L Carlson
- Neuroscience Curriculum, University of North Carolina, Chapel Hill, North Carolina
| | - Kai Xia
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - M Andrea Azcarate-Peril
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Microbiome Core Facility, University of North Carolina, Chapel Hill, North Carolina
| | - Barbara D Goldman
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina; Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Mihye Ahn
- Department of Mathematics and Statistics, University of Nevada, Reno, Nevada
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina; Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina
| | - Amanda L Thompson
- Department of Anthropology, University of North Carolina, Chapel Hill, North Carolina; Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Xiujuan Geng
- Department of Psychology Lab of Neuropsychology and Lab of Social Cognitive Affective Neuroscience, University of Hong Kong, Hong Kong; State Key Lab of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca C Knickmeyer
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.
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Valera-Gran D, Navarrete-Muñoz EM, Garcia de la Hera M, Fernández-Somoano A, Tardón A, Ibarluzea J, Balluerka N, Murcia M, González-Safont L, Romaguera D, Julvez J, Vioque J. Effect of maternal high dosages of folic acid supplements on neurocognitive development in children at 4-5 y of age: the prospective birth cohort Infancia y Medio Ambiente (INMA) study. Am J Clin Nutr 2017; 106:878-887. [PMID: 28724645 DOI: 10.3945/ajcn.117.152769] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The benefits of the use of folic acid supplements (FASs) during the periconception period to prevent neural tube defects and to ensure normal brain development in offspring are well known. There is concern, however, about the long-term effects of the maternal use of high dosages of FASs that exceed the Tolerable Upper Intake Level (UL) (≥1000 μg/d) on child neurocognitive outcomes.Objective: The objective of the study was to examine the association between the use of high dosages of FASs during pregnancy and child neuropsychological development at ages 4-5 y.Design: The multicenter prospective mother-child cohort study, the Infancia y Medio Ambiente (INMA) Project, was conducted in 4 regions of Spain: Asturias, Sabadell, Gipuzkoa, and Valencia. Pregnant women were recruited between 2003 and 2008. Data on 1682 mother-child pairs were included in the final analyses. The pregnant women completed an interviewer-administered questionnaire that was validated to estimate typical dietary folate intake and the use of FASs at 10-13 and 28-32 wk of gestation. Neuropsychological development scores at 4-5 y of age were estimated with the use of the McCarthy Scales of Children's Abilities. Multiple linear regression and meta-analysis were used to obtain combined-effect estimates.Results: During the periconception period, one-third of the women (n = 502) took FAS dosages ≥1000 μg/d. The use of FAS dosages ≥1000 μg/d in this period was negatively associated with several neuropsychological outcomes scores in children: global verbal (β = -2.49; 95% CI: -4.71, -0.27), verbal memory (β = -3.59; 95% CI: -6.95, -0.23), cognitive function of posterior cortex (β = -2.31; 95% CI: -4.45, -0.18), and cognitive function of left posterior cortex (β = -3.26; 95% CI: -5.51, -1.01).Conclusions: The use of FAS dosages exceeding the UL (≥1000 μg/d) during the periconception period was associated with lower levels of cognitive development in children aged 4-5 y. The use of FAS dosages ≥1000 μg/d during pregnancy should be monitored and prevented as much as possible, unless medically prescribed.
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Affiliation(s)
- Desirée Valera-Gran
- Department of Public Health, History of Medicine, and Gynecology, University Miguel Hernández, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Eva M Navarrete-Muñoz
- Department of Public Health, History of Medicine, and Gynecology, University Miguel Hernández, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Manuela Garcia de la Hera
- Department of Public Health, History of Medicine, and Gynecology, University Miguel Hernández, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Oviedo, Oviedo, Spain
| | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Oviedo, Oviedo, Spain
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Health Research Institute (BIODONOSTIA), San Sebastian, Spain
| | - Nekane Balluerka
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Social Psychology and Behavioral Sciences Methods, University of the Basque Country, San Sebastian, Spain
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,FISABIO-University of Valencia-University Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - Llúcia González-Safont
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,FISABIO-University of Valencia-University Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - Dora Romaguera
- Health Research Institute of Palma (IdISPa), Palma de Mallorca, Spain.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; and.,Spanish Consortium for Research on Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Jordi Julvez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; and
| | - Jesús Vioque
- Department of Public Health, History of Medicine, and Gynecology, University Miguel Hernández, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain; .,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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33
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Silva C, Keating E, Pinto E. The impact of folic acid supplementation on gestational and long term health: Critical temporal windows, benefits and risks. Porto Biomed J 2017; 2:315-332. [PMID: 32258789 DOI: 10.1016/j.pbj.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/10/2017] [Accepted: 05/31/2017] [Indexed: 01/23/2023] Open
Abstract
Highlights Associations between FA supplementation in pregnancy and effects on offspring's NTDs, allergy/respiratory problems, cancer and behaviour problems as been studied.There is growing concern about the effects of excessive FA supplementation, whether in terms of doses or times of exposure.FA supplementation in the periconceptional period is protective against NTDs while in later periods it could be deleterious.A daily dose of 0.4 mg FA in the periconceptional period seems to be effective and safe. Abstract Maternal folic acid (FA) supplementation is one of the most popular nutritional interventions during pregnancy for its protective effect against neural tube defects (NTDs).The purposes of this review are: (a) to gather the current evidence regarding supplementation of maternal diet with FA and (b) to problematize the available literature in terms of dosages, critical temporal windows, and its potential benefits and risks.The expression (pregnancy OR fetus OR offspring OR mother) AND ("folic acid" AND supplementation) was searched on PubMed database, filtering for articles published from 2005 to 2014. Publications referring to FA supplementation during the periconceptional period or pregnancy in which there was a conclusion about the effects of isolated FA supplementation on pregnant woman, pregnancy or offspring were included. Of the initial 1182 papers, 109 fulfilled the inclusion criteria.The majority of the publications reported FA supplementation outcomes on offspring's health, with emphasis in NTDs, allergy/respiratory problems, cancer and behaviour problems. Some inconsistency is observed on the impact of FA supplementation on different outcomes, except for NTDs. It is also visible an increased concern about the impact of excessive supplementation, either in terms of doses or exposure's duration.In conclusion, there is a growing interest in FA supplementation issues. The protective effect of FA supplementation over NTDs has been confirmed, being the periconceptional period a critical window, and it is frequently suggested that allergy/respiratory outcomes arise from (excessive) FA supplementation particularly later in pregnancy. Further research on critical doses and time of exposure should be conducted.
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Affiliation(s)
- Carla Silva
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elisa Keating
- Department of Biomedicine - Biochemistry Unit, Faculty of Medicine of University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Elisabete Pinto
- CBQF - Centre of Biotechnology and Fine Chemistry - School of Biotechnology, Portuguese Catholic University, Porto, Portugal.,Institute of Public Health of the University of Porto, Porto, Portugal
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Chatzi L, Leventakou V, Vafeiadi M, Koutra K, Roumeliotaki T, Chalkiadaki G, Karachaliou M, Daraki V, Kyriklaki A, Kampouri M, Fthenou E, Sarri K, Vassilaki M, Fasoulaki M, Bitsios P, Koutis A, Stephanou EG, Kogevinas M. Cohort Profile: The Mother-Child Cohort in Crete, Greece (Rhea Study). Int J Epidemiol 2017; 46:1392-1393k. [DOI: 10.1093/ije/dyx084] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
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35
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Freitas-Vilela AA, Pearson RM, Emmett P, Heron J, Smith ADAC, Emond A, Hibbeln JR, Castro MBT, Kac G. Maternal dietary patterns during pregnancy and intelligence quotients in the offspring at 8 years of age: Findings from the ALSPAC cohort. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28251825 PMCID: PMC5763349 DOI: 10.1111/mcn.12431] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 01/10/2023]
Abstract
Dietary intake during pregnancy may influence child neurodevelopment and cognitive function. This study aims to investigate the associations between dietary patterns obtained in pregnancy and intelligence quotients (IQ) among offspring at 8 years of age. Pregnant women enrolled in the Avon Longitudinal Study of Parents and Children completed a food frequency questionnaire at 32 weeks' gestation (n = 12,195). Dietary patterns were obtained by cluster analysis. Three clusters best described women's diets during pregnancy: “fruit and vegetables,” “meat and potatoes,” and “white bread and coffee.” The offspring's IQ at 8 years of age was assessed using the Wechsler Intelligence Scale for Children. Models, using variables correlated to IQ data, were performed to impute missing values. Linear regression models were employed to investigate associations between the maternal clusters and IQ in childhood. Children of women who were classified in the meat and potatoes cluster and white bread and coffee cluster during pregnancy had lower average verbal (β = −1.74; p < .001 and β = −3.05; p < .001), performance (β = −1.26; p = .011 and β = −1.75; p < .001), and full‐scale IQ (β = −1.74; p < .001 and β = −2.79; p < .001) at 8 years of age when compared to children of mothers in the fruit and vegetables cluster in imputed models of IQ and all confounders, after adjustment for a wide range of known confounders including maternal education. The pregnant women who were classified in the fruit and vegetables cluster had offspring with higher average IQ compared with offspring of mothers in the meat and potatoes cluster and white bread and coffee cluster.
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Affiliation(s)
- Ana Amélia Freitas-Vilela
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Rebecca M Pearson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Pauline Emmett
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew D A C Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan Emond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Joseph R Hibbeln
- Section of Nutritional Neurosciences, Laboratory of Membrane Biology and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Beatriz Trindade Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
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36
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McKay JA, Xie L, Adriaens M, Evelo CT, Ford D, Mathers JC. Maternal folate depletion during early development and high fat feeding from weaning elicit similar changes in gene expression, but not in DNA methylation, in adult offspring. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201600713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jill A. McKay
- Human Nutrition Research Centre; Institute for Health and Society; Newcastle University; UK
| | - Long Xie
- Human Nutrition Research Centre, Institute of Cellular Medicine; Newcastle University; UK
| | - Michiel Adriaens
- Maastricht Centre for Systems Biology; Maastricht The Netherlands
| | - Chris T. Evelo
- Department of Bioinformatics - BiGCaT; Maastricht University; Maastricht The Netherlands
| | - Dianne Ford
- Human Nutrition Research Centre, Institute for Cell and Molecular Biosciences; Newcastle University; UK
- Faculty of Health and Life Sciences; Northumbria University; UK
| | - John C. Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine; Newcastle University; UK
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37
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Gao Y, Sheng C, Xie RH, Sun W, Asztalos E, Moddemann D, Zwaigenbaum L, Walker M, Wen SW. New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children - A Systematic Review. PLoS One 2016; 11:e0165626. [PMID: 27875541 PMCID: PMC5119728 DOI: 10.1371/journal.pone.0165626] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 10/14/2016] [Indexed: 11/20/2022] Open
Abstract
It has been conclusively established that folic acid supplementation prior to and during early pregnancy (up to 12 weeks of gestation) can prevent neural tube defects (NTDs). We hypothesized that folate effects may extend from neuro-structural defects to alterations in neuro-behavioural and emotional skills including autism spectrum disorders (ASDs) and other developmental disorders. The objective of this review was to comprehensively evaluate evidence on the impact of folic acid on neurodevelopment other than NTDs. We conducted an online search of relevant literature compiled by the National Library of Medicine from Medline and EMBASE (searched on Dec 31, 2014: http://www.ncbi.nlm.nih.gov/entrez/query/fcgi and http://www.elsevier.com/online-tools/embase). We first created 3 files (search restricted to English literature) using the following key words: 1) folate or folic acid (171322 papers identified by this search); 2) maternal or pregnancy or pregnant or gestation or gestational or prenatal or antenatal or periconception or periconceptional (1349219 papers identified by this search); and 3) autism or autism spectrum disorders or developmental delay or development or neurodevelopment or mental or cognitive or language or personal-social or gross motor or fine motor or behaviour or intellectual or intelligence or Bayley Scale (8268145 papers identified by this search). We then merged the 3 files and reviewed the papers that addressed these three issues simultaneously. A total of 22 original papers that examined the association between folic acid supplementation in human pregnancy and neurodevelopment/autism were identified after the screening, with 15 studies showing a beneficial effect of folic acid supplementation on neurodevelopment/autism, 6 studies showed no statistically significant difference, while one study showed a harmful effect in > 5 mg folic acid supplementation/day during pregnancy. Folic acid supplementation in pregnancy may have beneficial effects on the neurodevelopment of children beyond its proven effect on NTDs.
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Affiliation(s)
- Yunfei Gao
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Chao Sheng
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Ri-hua Xie
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
- Hunan University of Medicine Department of Nursing, Huaihua, Hunan, China
- McLaughlin Center for Population Risk Assessment, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Wen Sun
- Department of Obstetrics and Gynecology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Elizabeth Asztalos
- Centre for Mother, Infant and Child Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Departments of Pediatrics and Obstetrics and Gynecology Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Diane Moddemann
- Department of Pediatrics and Child Health and Neonatal Follow-up Program, University of Manitoba, Winnipeg, Canada
| | - Lonnie Zwaigenbaum
- Departments of Pediatrics and of Psychiatry, University of Alberta, Edmonton, Canada
- Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Mark Walker
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Shi Wu Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Canada
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38
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Organ-Specific Gene Expression Changes in the Fetal Liver and Placenta in Response to Maternal Folate Depletion. Nutrients 2016; 8:nu8100661. [PMID: 27782079 PMCID: PMC5084047 DOI: 10.3390/nu8100661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/25/2023] Open
Abstract
Growing evidence supports the hypothesis that the in utero environment can have profound implications for fetal development and later life offspring health. Current theory suggests conditions experienced in utero prepare, or "programme", the fetus for its anticipated post-natal environment. The mechanisms responsible for these programming events are poorly understood but are likely to involve gene expression changes. Folate is essential for normal fetal development and inadequate maternal folate supply during pregnancy has long term adverse effects for offspring. We tested the hypothesis that folate depletion during pregnancy alters offspring programming through altered gene expression. Female C57BL/6J mice were fed diets containing 2 mg or 0.4 mg folic acid/kg for 4 weeks before mating and throughout pregnancy. At 17.5 day gestation, genome-wide gene expression was measured in male fetal livers and placentas. In the fetal liver, 989 genes were expressed differentially (555 up-regulated, 434 down-regulated) in response to maternal folate depletion, with 460 genes expressed differentially (250 up-regulated, 255 down-regulated) in the placenta. Only 25 differentially expressed genes were common between organs. Maternal folate intake during pregnancy influences fetal gene expression in a highly organ specific manner which may reflect organ-specific functions.
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Gerard EE, Meador KJ. An Update on Maternal Use of Antiepileptic Medications in Pregnancy and Neurodevelopment Outcomes. J Pediatr Genet 2016; 4:94-110. [PMID: 27617120 DOI: 10.1055/s-0035-1556741] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Antiepileptic drugs (AEDs) are prescribed commonly to women of childbearing age. In utero exposure to some AEDs can have significant cognitive and behavioral consequences for the unborn child. Recently, prospective studies of women taking AEDs during pregnancy have added significantly to our understanding of cognitive and behavioral teratogenic risks posed by fetal AED exposure. Valproate is clearly associated with impaired cognitive development as well as an increased risk of disorders such as autism and autism spectrum disorder. Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin monotherapy is associated with more favorable cognitive and behavioral outcomes than valproate, but more data are required to clarify if these AEDs have more subtle effects on cognition and behavior. There are insufficient data on the developmental effects of other AEDs in humans. Further, the underlying mechanisms of cognitive teratogenesis are poorly understood, including the genetic factors that affect susceptibility to AEDs.
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Affiliation(s)
- Elizabeth E Gerard
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, United States
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40
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Irwin RE, Pentieva K, Cassidy T, Lees-Murdock DJ, McLaughlin M, Prasad G, McNulty H, Walsh CP. The interplay between DNA methylation, folate and neurocognitive development. Epigenomics 2016; 8:863-79. [PMID: 27319574 DOI: 10.2217/epi-2016-0003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
DNA methylation provides an attractive possible means for propagating the effects of environmental inputs during fetal life and impacting subsequent adult mental health, which is leading to increasing collaboration between molecular biologists, nutritionists and psychiatrists. An area of interest is the potential role of folate, not just in neural tube closure in early pregnancy, but in later major neurodevelopmental events, with consequences for later sociocognitive maturation. Here, we set the scene for recent discoveries by reviewing the major events of neural development during fetal life, with an emphasis on tissues and structures where dynamic methylation changes are known to occur. Following this, we give an indication of some of the major classes of genes targeted by methylation and important for neurological and behavioral development. Finally, we highlight some cognitive disorders where methylation changes are implicated as playing an important role.
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Affiliation(s)
- Rachelle E Irwin
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Kristina Pentieva
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Tony Cassidy
- EpiFASSTT study, Psychology, Ulster University, Coleraine, UK
| | | | | | - Girijesh Prasad
- EpiFASSTT study, Computer Sciences Research Institutes, Ulster University, Londonderry, UK
| | - Helene McNulty
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Colum P Walsh
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
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41
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McKay JA, Adriaens M, Evelo CT, Ford D, Mathers JC. Gene promoter DNA methylation patterns have a limited role in orchestrating transcriptional changes in the fetal liver in response to maternal folate depletion during pregnancy. Mol Nutr Food Res 2016; 60:2031-42. [PMID: 27133805 PMCID: PMC5031189 DOI: 10.1002/mnfr.201600079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/12/2022]
Abstract
SCOPE Early-life exposures are critical in fetal programming and may influence function and health in later life. Adequate maternal folate consumption during pregnancy is essential for healthy fetal development and long-term offspring health. The mechanisms underlying fetal programming are poorly understood, but are likely to involve gene regulation. Epigenetic marks, including DNA methylation, regulate gene expression and are modifiable by folate supply. We observed transcriptional changes in fetal liver in response to maternal folate depletion and hypothesized that these changes are concomitant with altered gene promoter methylation. METHODS AND RESULTS Female C57BL/6J mice were fed diets containing 2 or 0.4 mg folic acid/kg for 4 wk before mating and throughout pregnancy. At 17.5-day gestation, genome-wide gene expression and promoter methylation were measured by microarray analysis in male fetal livers. While 989 genes were differentially expressed, 333 promoters had altered methylation (247 hypermethylated, 86 hypomethylated) in response to maternal folate depletion. Only 16 genes had both expression and methylation changes. However, most methylation changes occurred in genomic regions neighboring expression changes. CONCLUSION In response to maternal folate depletion, altered expression at the mRNA level was not associated with altered promoter methylation of the same gene in fetal liver.
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Affiliation(s)
- Jill A McKay
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Michiel Adriaens
- Maastricht Centre for Systems Biology-MaCSBio, Maastricht University, Maastricht, the Netherlands
| | - Chris T Evelo
- Department of Bioinformatics-BiGCaT, Maastricht University, Maastricht, the Netherlands
| | - Dianne Ford
- Human Nutrition Research Centre, Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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42
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Wiens D, DeWitt A, Kosar M, Underriner C, Finsand M, Freese M. Influence of Folic Acid on Neural Connectivity during Dorsal Root Ganglion Neurogenesis. Cells Tissues Organs 2016; 201:342-53. [PMID: 27160668 DOI: 10.1159/000444389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
The vitamin folic acid (FA) is essential for DNA synthesis, repair and methylation, and for methionine synthesis. Although it is necessary for neural development, recent studies suggest a possible link between excess maternal supplemental FA intake and adverse interferences with single-carbon metabolism and neural development. Insufficient FA early in brain development can lead to failure of the neural tube closure, but the consequences of too much intake have not been fully investigated. Plasma FA concentrations can increase greatly with dietary supplementation. To model the development of neural connectivity, we cultured dorsal root ganglia (DRGs) taken from 8-day-old chick embryos in a range of pteroylmonoglutamate (PteGlu, synthetic supplemental FA) concentrations. DRGs were cultured for 36 h, fixed and immunostained to reveal the locations of neural networks with synaptic vesicles. We found a concentration-dependent relationship with significant reduction in neurite length in PteGlu concentrations from 0.25 to 20 μM. The average total of stained synaptic areas surrounding each cultured DRG was significantly reduced as well. To further characterize the effects, we carried out time-lapse imaging of growth cones at terminals of extending neurites. We found that PteGlu reduced the area-changing activity of the growth cone, hindering its exploratory capabilities, along with a tendency to inhibit overall advancement, thus altering the ability to extend and form synapses. Our results show that PteGlu at 250 nM and higher reduces neurite extension and synapse formation in a dose-dependent manner during neurogenesis, and that its effect is mediated through inhibition of growth cone motility.
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Affiliation(s)
- Darrell Wiens
- Department of Biology, University of Northern Iowa, Cedar Falls, Iowa, USA
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43
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Ruiz JDC, Quackenboss JJ, Tulve NS. Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review. PLoS One 2016; 11:e0147741. [PMID: 26840411 PMCID: PMC4739499 DOI: 10.1371/journal.pone.0147741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022] Open
Abstract
The etiology of a child’s cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children’s cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003–2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child’s total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child’s ability to learn.
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Affiliation(s)
- Jazmin Del Carmen Ruiz
- Oak Ridge Institute for Science and Education, Research Participation Program, Oak Ridge, TN, United States of America
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
- * E-mail: ;
| | - James J. Quackenboss
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Las Vegas, NV, United States of America
| | - Nicolle S. Tulve
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
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Effects of prenatal and/or postnatal supplementation with iron, PUFA or folic acid on neurodevelopment: update. Br J Nutr 2016; 122:S10-S15. [DOI: 10.1017/s0007114514004243] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractNeurodevelopment has been linked, among other factors, to maternal and early infant diets. The objective of this review, which is part of the NUTRIMENTHE research project ‘The effect of diet on the mental performance of children’ (www.nutrimenthe.com), was to update current evidence on the effects of nutritional interventions such as iron, folic acid or n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy and/or in early life on the mental performance and psychomotor development of children. In May 2014, we searched MEDLINE and The Cochrane Database of Systematic Reviews for relevant studies published since 2009. The limited updated evidence suggests that iron supplementation of infants may positively influence the psychomotor development of children, although it does not seem to alter their mental development or behaviour. The use of multivitamin-containing folic acid supplements during pregnancy did not benefit the mental performance of the offspring. Evidence from randomised controlled trials (RCT) did not show a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on childhood cognitive and visual development. Caution is needed when interpreting current evidence, as many of the included trials had methodological limitations such as small sample sizes, high attrition rates, and no intention-to-treat analyses. Taken together, the evidence is still inconclusive. Large, high-quality RCT to assess the effects of supplementation with iron, LCPUFA or folic acid are still needed to further clarify the effects of these, and other nutrients, on neurodevelopment. Recent recommendations from scientific societies are briefly presented.
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Abstract
The clinical management of women with epilepsy on antiepileptic drugs (AEDs) during pregnancy presents unique challenges. The goal of treatment is optimal seizure control with minimal in utero fetal exposure to AEDs in an effort to reduce the risk of structural and neurodevelopmental teratogenic effects. This paper reviews the following key issues pertaining to women with epilepsy during pregnancy: AED pharmacokinetics; clinical management of AEDs; seizure frequency; major congenital malformation; neurodevelopmental outcomes; perinatal complications; and breast feeding.
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Affiliation(s)
- Sima I Patel
- Department of Neurology, University of Minnesota Health/MINCEP Epilepsy Care, 5775 Wayzata Blvd, Minneapolis, MN 55416, USA
| | - Page B Pennell
- Department of Neurology, Divisions of Epilepsy and Women's Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Shorter KR, Felder MR, Vrana PB. Consequences of dietary methyl donor supplements: Is more always better? PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 118:14-20. [PMID: 25841986 DOI: 10.1016/j.pbiomolbio.2015.03.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/11/2015] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
Abstract
Epigenetic mechanisms are now recognized to play roles in disease etiology. Several diseases increasing in frequency are associated with altered DNA methylation. DNA methylation is accomplished through metabolism of methyl donors such as folate, vitamin B12, methionine, betaine (trimethylglycine), and choline. Increased intake of these compounds correlates with decreased neural tube defects, although this mechanism is not well understood. Consumption of these methyl donor pathway components has increased in recent years due to fortification of grains and high supplemental levels of these compounds (e.g. vitamins, energy drinks). Additionally, people with mutations in one of the enzymes that assists in the methyl donor pathway (5-MTHFR) are directed to consume higher amounts of methyl donors to compensate. Recent evidence suggests that high levels of methyl donor intake may also have detrimental effects. Individualized medicine may be necessary to determine the appropriate amounts of methyl donors to be consumed, particularly in women of child bearing age.
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Affiliation(s)
- Kimberly R Shorter
- University of Florida School of Medicine, Department of Psychiatry at the McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, USA
| | - Michael R Felder
- University of South Carolina, Department of Biological Sciences, 715 Sumter Street, Columbia, SC 29208, USA; Peromyscus Genetic Stock Center, University of South Carolina, 715 Sumter Street, Columbia, SC 29208, USA
| | - Paul B Vrana
- University of South Carolina, Department of Biological Sciences, 715 Sumter Street, Columbia, SC 29208, USA; Peromyscus Genetic Stock Center, University of South Carolina, 715 Sumter Street, Columbia, SC 29208, USA.
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Abstract
Nutrition plays a fundamental role in supporting the structural and functional development of the human brain from conception, throughout early infancy and extending into later life. A growing body of evidence suggests that folate and the metabolically related B-vitamins are essential for brain health across all age groups, owing to their specific roles in C1 metabolism and particularly in the production of S-adenosylmethionine, a universal methyl donor essential for the production of neurotransmitters. Emerging, though not entirely consistent, evidence suggests that maternal folate status throughout pregnancy may influence neurodevelopment and behaviour of the offspring. Furthermore optimal B-vitamin status is associated with better cognitive health in ageing. Of note, a recent clinical trial provided evidence that supplementation with folic acid and related B-vitamins over a 2-year-period reduced global and regional brain atrophy, as measured by MRI scan in older adults. In terms of potential mechanisms, the effects of these B-vitamins on cognitive health may be independent or may be mediated by nutrient-nutrient and/or relevant gene-nutrient interactions. Furthermore, a new area of research suggests that the in utero environment influences health in later life. Folate, an important cofactor in C1 metabolism, is indirectly involved in DNA methylation, which in turn is considered to be one of the epigenetic mechanisms that may underlie fetal programming and brain development. The present review will explore the evidence that supports a role for folate and the related B-vitamins in brain health across the lifecycle, and potential mechanisms to explain such effects.
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Barua S, Kuizon S, Junaid MA. Folic acid supplementation in pregnancy and implications in health and disease. J Biomed Sci 2014; 21:77. [PMID: 25135350 PMCID: PMC4237823 DOI: 10.1186/s12929-014-0077-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022] Open
Abstract
Maternal exposure to dietary factors during pregnancy can influence embryonic development and may modulate the phenotype of offspring through epigenetic programming. Folate is critical for nucleotide synthesis, and preconceptional intake of dietary folic acid (FA) is credited with reduced incidences of neural tube defects in infants. While fortification of grains with FA resulted in a positive public-health outcome, concern has been raised for the need for further investigation of unintended consequences and potential health hazards arising from excessive FA intakes, especially following reports that FA may exert epigenetic effects. The objective of this article is to discuss the role of FA in human health and to review the benefits, concerns and epigenetic effects of maternal FA on the basis of recent findings that are important to design future studies.
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Affiliation(s)
- Subit Barua
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Salomon Kuizon
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Mohammed A Junaid
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
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Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
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Vanhees K, Vonhögen IGC, van Schooten FJ, Godschalk RWL. You are what you eat, and so are your children: the impact of micronutrients on the epigenetic programming of offspring. Cell Mol Life Sci 2014; 71:271-85. [PMID: 23892892 PMCID: PMC11113902 DOI: 10.1007/s00018-013-1427-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
The research field of fetal programming has developed tremendously over the years and increasing knowledge suggests that both maternal and paternal unbalanced diet can have long-lasting effects on the health of offspring. Studies implicate that macronutrients play an important role in fetal programming, although the importance of micronutrients is also becoming increasingly apparent. Folic acid and vitamins B2, B6 and B12 are essential for one-carbon metabolism and are involved in DNA methylation. They can therefore influence the programming of the offspring's epigenome. Also, other micronutrients such as vitamins A and C, iron, chromium, zinc and flavonoids play a role in fetal programming. Since it is estimated that approximately 78 % of pregnant women in the US take vitamin supplements during pregnancy, more attention should be given to the long-term effects of these supplements on offspring. In this review we address several different studies which illustrate that an unbalanced diet prior and during pregnancy, regarding the intake of micronutrients of both mother and father, can have long-lasting effects on the health of adult offspring.
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Affiliation(s)
- Kimberly Vanhees
- Department of Toxicology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht UMC+, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
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