The effects of maternal folic acid and vitamin C nutrition in early pregnancy on reproductive performance in the guinea-pig

Maternal Vitamin C Intake during Pregnancy Influences Long-Term Offspring Growth with Timing- and Sex-Specific Effects in Guinea Pigs

Our previous work in guinea pigs revealed that low vitamin C intake during preconception and pregnancy adversely affects fertility, pregnancy outcomes, and foetal and neonatal growth in a sex-dependent manner. To investigate the long-term impact on offspring, we monitored their growth from birth to adolescence (four months), recorded organ weights at childhood equivalence (28 days) and adolescence, and assessed physiological parameters like oral glucose tolerance and basal cortisol concentrations. We also investigated the effects of the timing of maternal vitamin C restriction (early vs. late gestation) on pregnancy outcomes and the health consequences for offspring. Dunkin Hartley guinea pigs were fed an optimal (900 mg/kg feed) or low (100 mg/kg feed) vitamin C diet ad libitum during preconception. Pregnant dams were then randomised into four feeding regimens: consistently optimal, consistently low, low during early pregnancy, or low during late pregnancy. We found that low maternal vitamin C intake during early pregnancy accelerated foetal and neonatal growth in female offspring and altered glucose homeostasis in the offspring of both sexes at an age equivalent to early childhood. Conversely, low maternal vitamin C intake during late pregnancy resulted in foetal growth restriction and reduced weight gain in male offspring throughout their lifespan. We conclude that altered vitamin C during development has long-lasting, sex-specific consequences for offspring and that the timing of vitamin C depletion is also critical, with low levels during early development being associated with the development of a metabolic syndrome-related phenotype, while later deprivation appears to be linked to a growth-faltering phenotype.

Effects of Low Vitamin C Intake on Fertility Parameters and Pregnancy Outcomes in Guinea Pigs

Identifying how specific nutrients can impact fertility, pregnancy, and neonatal outcomes will yield important insights into the biological mechanisms linking diet and reproductive health. Our study investigates how dietary vitamin C intake affects various fertility parameters and pregnancy and neonatal outcomes in the guinea pig, a natural model of vitamin C dependency. Dunkin Hartley guinea pigs were fed an optimal (900 mg/kg feed) or low (100 mg/kg feed) vitamin C diet ad libitum for at least three weeks prior to mating and throughout pregnancy. We found that animals receiving the low vitamin C diet had an increased number of unsuccessful matings, a higher incidence of foetal reabsorption, and, among pregnancies resulting in delivery at term, produced fewer offspring. Neonates from mothers on the low vitamin C diet had significantly decreased plasma vitamin C concentrations at birth and exhibited mild growth impairments in a sex-dependent manner. We conclude that a diet low of vitamin C induces a state of subfertility, reduces overall fecundity, and adversely impacts both pregnancy outcomes and growth in the offspring. Our study provides an essential foundation for future investigations to determine whether these findings translate to humans. If so, they could have important clinical implications for assisted reproductive technologies and nutritional recommendations for couples trying to conceive, pregnant women, and breastfeeding mothers.

Ascorbic acid intake during pregnancy

The continuing global increase in allergic conditions and diseases in children is now a serious public health and scientific issue. Amongst other concerns is the maternal antenatal diet as intake of essential nutrients. Even small deficits in essential vitamin C can permanently impair the developing brain for example. In this article, we first review ascorbic acid deficiency in different organs of both mother and foetus. However, major emphasis is on the importance of vitamin C in foetal immunity with studies showing an inverse relationship between maternal intake of fresh fruit and vegetables and allergic conditions in childhood, inter alia. Other review results are included.

The Epigenetic Role of Vitamin C in Neurodevelopment

The maternal diet during pregnancy is a key determinant of offspring health. Early studies have linked poor maternal nutrition during gestation with a propensity for the development of chronic conditions in offspring. These conditions include cardiovascular disease, type 2 diabetes and even compromised mental health. While multiple factors may contribute to these outcomes, disturbed epigenetic programming during early development is one potential biological mechanism. The epigenome is programmed primarily in utero, and during this time, the developing fetus is highly susceptible to environmental factors such as nutritional insults. During neurodevelopment, epigenetic programming coordinates the formation of primitive central nervous system structures, neurogenesis, and neuroplasticity. Dysregulated epigenetic programming has been implicated in the aetiology of several neurodevelopmental disorders such as Tatton-Brown-Rahman syndrome. Accordingly, there is great interest in determining how maternal nutrient availability in pregnancy might affect the epigenetic status of offspring, and how such influences may present phenotypically. In recent years, a number of epigenetic enzymes that are active during embryonic development have been found to require vitamin C as a cofactor. These enzymes include the ten-eleven translocation methylcytosine dioxygenases (TETs) and the Jumonji C domain-containing histone lysine demethylases that catalyse the oxidative removal of methyl groups on cytosines and histone lysine residues, respectively. These enzymes are integral to epigenetic regulation and have fundamental roles in cellular differentiation, the maintenance of pluripotency and development. The dependence of these enzymes on vitamin C for optimal catalytic activity illustrates a potentially critical contribution of the nutrient during mammalian development. These insights also highlight a potential risk associated with vitamin C insufficiency during pregnancy. The link between vitamin C insufficiency and development is particularly apparent in the context of neurodevelopment and high vitamin C concentrations in the brain are indicative of important functional requirements in this organ. Accordingly, this review considers the evidence for the potential impact of maternal vitamin C status on neurodevelopmental epigenetics.

Folic acid and flaxseed oil supplements in Ossimi ewes: effect on body weight changes, progesterone profile, blood chemistry, and litter traits

The aim was to explore the impact of periconceptional folic acid or flaxseed oil (FXO) supplementation on fertility, progesterone profile, and blood chemistry in pregnant ewes during the breeding season. In total, 54 Ossimi ewes were divided into three groups (18 animals each). The control treatment (CON) fed a basal diet only, while the others fed the basal diet and supplemented every other day with a single bolus of folic acid (FO 500 μg/head) or flaxseed oil (FX 50 ml/head). During the early stage of pregnancy, the FO and FX groups showed significantly higher serum antioxidant activity (glutathione and superoxide dismutase) as compared with the control CON group (P = 0.012 and 0.007, respectively). Although no significant variations were detected in the serum nitric oxide levels during the early stage and mid-stage of pregnancy, the FO and FX groups showed significantly lower serum nitric oxide concentration in the late stage of pregnancy (P = 0.001). The FO and FX groups showed significantly higher serum progesterone concentrations during the early stage (10.9 and 11.4 ng/ml, respectively) and mid-stage (22.2 and 23.4 ng/ml, respectively) of pregnancy as compared with the CON group (7.72 and 13.9 ng/ml, respectively). The FX group exhibited a significantly higher lambing rate (P = 0.034), as well as the proportion of female lambs (P = 0.029) as compared with the CON group. In conclusion, supplementing Ossimi ewes with folic acid or FXO significantly improved the progesterone profile during pregnancy. Moreover, the FXO supplementation significantly increased the lambing rate and the female lamb rate as compared with the control group.

Dietary folate and reproductive success among women undergoing assisted reproduction

OBJECTIVE

To prospectively evaluate the associations of folate with assisted reproductive technology outcomes within a population in the United States.

METHODS

This analysis included women (n=232) in a prospective cohort study at the Massachusetts General Hospital Fertility Center. Diet was assessed before assisted reproductive technology treatment using a validated food frequency questionnaire. Intermediate and clinical endpoints of assisted reproductive technology were abstracted from medical records. Generalized linear mixed models with random intercepts to account for multiple cycles per woman were used to evaluate the association of folate intake with assisted reproductive technology outcomes adjusting for calorie intake, age, body mass index, race, smoking status, infertility diagnosis, and protocol type.

RESULTS

Among the 232 women (median age 35.2 years, median folate intake 1,778 micrograms/day), higher folate intake was associated with higher rates of implantation, clinical pregnancy, and live birth. The adjusted percentage (95% confidence interval [CI]) of initiated assisted reproductive technology cycles resulting in a live birth for women in increasing quartiles of folate intake were 30% (95% CI 21-42%), 47% (95% CI 35-59%), 42% (95% CI 30-35%) and 56% (95% CI 43-67%) (P for trend=0.01). Live birth rates were 20% (95% CI 8-31%) higher among women in the highest quartile of supplemental folate intake (more than 800 micrograms/day) than among women in the lowest quartile (less than 400 micrograms/day). Higher supplemental folate intake was associated with higher fertilization rates and lower cycle failure rates before embryo transfer (P for trend=0.03 and 0.02).

CONCLUSION

Higher intake of supplemental folate was associated with higher live birth rates after assisted reproductive technology treatment.

LEVEL OF EVIDENCE

: II.

Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth

OBJECTIVE

To evaluate prospectively the relationship between prepregnancy folate intake and risk of spontaneous abortion and stillbirth.

METHODS

Women in the Nurses' Health Study II who self-reported a pregnancy between 1992 and 2009 were included in this analysis. Dietary folate and supplement use was assessed every 4 years, starting in 1991, by a food frequency questionnaire. Pregnancies were self-reported with case pregnancies lost spontaneously (spontaneous abortion less than 20 weeks of gestation and stillbirth 20+ weeks of gestation) and comparison pregnancies ending in ectopic pregnancy, induced abortion, or live birth.

RESULTS

Among the 11,072 women, 15,950 pregnancies were reported of which 2,756 (17.3%) ended in spontaneous abortion and 120 (0.8%) ended in stillbirth. Compared with women in the lowest quintile of prepregnancy folate intake (less than 285 micrograms/d), those in the highest quintile (greater than 851 micrograms/d) had a relative risk of spontaneous abortion of 0.91 (95% confidence interval [CI] 0.82-1.02) after multivariable adjustment (P trend=.04). This association was primarily attributable to intake of folate from supplements. Compared with women without supplemental folate intake (0 micrograms/d), those in the highest category (greater than 730 micrograms/d) had a relative risk of spontaneous abortion of 0.80 (95% CI 0.71-0.90) after multivariable adjustment (P trend <.001). The association of prepregnancy supplemental folate with risk of spontaneous abortion was consistent across gestational period of loss. A similar inverse trend was observed with the risk of stillbirth, which fell short of conventional significance (P trend=.06).

CONCLUSIONS

Higher intake of folate from supplements was associated with reduced risk of spontaneous abortion. Women at risk of pregnancy should use supplemental folate for neural tube defect prevention and because it may decrease the risk of spontaneous abortion.

LEVEL OF EVIDENCE

: II.

Methylenetetrahydrofolate reductase C677T polymorphism and pregnancy complications

OBJECTIVE

To investigate the frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in women with intrauterine fetal death, preeclampsia, preterm delivery, and small for gestational age (SGA) infants.

METHODS

In a prospective cohort study, DNA from 2,000 pregnant women were analyzed for MTHFR C677T by DNA microarray (wild-type allele, C; mutant allele, T).

RESULTS

One thousand six hundred seventy-five women completed the study. Of these, 16.6% (278 women with 556 genetic alleles) developed at least one pregnancy complication and were designated study cases. There were 1,397 women (with 2,794 genetic alleles) who served as controls. MTHFR C677T allele frequencies were significantly different between cases and controls (C [wild-type]: 346 of 556 [62%]; T [mutant]: 210 of 556 [38%] compared with C: 1,911 of 2,794 [68%]; T: 883 of 2,794 [32%]; P=.005; odds ratio [OR] 1.23, 95% confidence interval [CI] 1.06-1.42). Genotype distributions were also different between cases and controls (C/T+T/T [abnormal]: 174 of 278 [63%]; C/C [normal]: 104 of 278 [37%] compared with C/T+T/T: 728 of 1,397 [52%]; C/C 669 of 1,397 [48%]; P=.002; OR 1.54, 95% CI 1.18-2.02). The clinical effect of the MTHFR C677T polymorphism was restricted to women with SGA infants (P=.05; OR 1.33, 95% CI 1.00-1.77). No significant differences in genotype distributions were observed among women with intrauterine fetal death, preeclampsia, and preterm delivery.

CONCLUSION

MTHFR C677T is a genetic marker for identifying women at increased risk of SGA infants.

LEVEL OF EVIDENCE

II.

The effects of maternal intake and gestational age on materno-fetal transport of vitamin C in the guinea-pig

The effects of maternal intake and gestational age on materno-fetal transport of vitamin C were investigated in female Dunkin-Hartley guinea-pigs. Twenty-four time-mated dams were fed on either a moderate-vitamin C (group A) or a high-vitamin C (group B) diet, throughout pregnancy. At days 49, 63 and 66 of gestation, and at term, three animals from each group were killed and fetuses removed by hysterectomy. Plasma, liver, kidney, lungs, heart, placenta and amniotic fluid were collected from dams and fetuses and subsequently analysed for vitamin C. Fetal plasma and amniotic fluid concentrations showed negative associations with gestational age for both dietary groups, independent of an effect of dam (P < 0.001). A similar, though not significant, effect of gestational age was observed on placental vitamin C and group A fetal tissue concentrations. Fetal plasma, placental and amniotic fluid vitamin C concentrations were significantly higher in group B than group A (P < 0.001), suggesting the influence of maternal diet. Although the level of maternal vitamin C intake can influence the circulating concentration in the fetus, there is a decrease associated with increasing gestational age, independent of the maternal diet. The gestational age-dependent change in the fetal accumulation of vitamin C may reflect changes in the rate of placental transfer.

Plasma reduced folates, reproductive performance, and conceptus development in sows in response to supplementation with oxidized and reduced sources of folic acid

The study was conducted to determine the response of sows to oxidized and reduced forms of supplemental folic acid in the diet. Gilts were mated and fed a standard corn-soybean meal diet with no supplemental folic acid. On d 105 of gestation, gilts were randomly assigned to one of four dietary treatments for the remainder of the study. Treatments were: 1) diet with no supplemental folate (control), 2) diet with 2.1 ppm (calculated) of added folate supplied by a synthetic pteroylmonoglutamate form (MG), 3) diet with 2.1 ppm (calculated) of added folate supplied by N5-formyl-5,6,7,8-tetrahydrofolic acid (THFA), or 4) a commercial bacterial cell powder source (Aj-PG) rich in reduced folates. Blood samples for high-performance liquid chromotography determination of reduced plasma folates were collected from gilts on d 105 of gestation, at weaning, at mating, and when the females were slaughtered on d 45 after mating for the second parity. There were 19, 18, 18, and 22 sows for the control, MG, THFA, and Aj-PG treatments, respectively. Supplementing folacin just before farrowing and during lactation had no effect on sow and litter performance during parity 1 (P > 0.10). Live fetuses at d 45 of gestation in Parity 2 were 10.06, 12.23, 10.87, and 11.07 for the control, MG, THFA, and Aj-PG treatments, respectively, and did not differ (P > 0.10). Fetal survival and placental size and protein content were generally unaffected by folate treatment. Concentration of reduced folates in sow plasma was 13.50, 13.58, 22.50, and 17.79 nM at weaning and 12.55, 19.29, 18.96, and 21.88 nM at mating for the control, MG, THFA, and Aj-PG treatments, respectively, with the THFA treatment elevated above the controls at weaning (P < 0.05) and the Aj-PG treatment greater than controls at mating (P < 0.05). At weaning, the reduced sources of supplemental folate (THFA and Aj-PG) were more effective in elevating plasma reduced folates than the oxidized folate supplement (MG; P < 0.05). Nonetheless, folate supplementation did not significantly improve sow reproductive performance in the subsequent parity, and there was no indication that reduced folate sources were superior to the oxidized pteroylmonoglutamate form as folate supplements for sows.

Effects of folate deficiency on embryonic development

While there is strong evidence that folate deficiency including the use of anti-folate drugs in early pregnancy is teratogenic and may lead to a range of serious abnormalities of the developing fetus including intrauterine death, the mechanism(s) for these effects have not yet been delineated. In neural tube defects, there is increasing evidence that marginal folate status exacerbates the effect of an underlying genetic defect in the mother, the fetus, or both. An abnormal relationship between the ingestion of folate and the folate levels in red blood cells has been found in women who have given birth to infants with neural tube defects. Periconceptional folate supplementation has been shown to give effective protection against the development of neural tube defects. The mechanism of the prevention is as yet unknown. However, folic acid will not prevent all cases of neural tube defect. Moreover, neither determinations of periconceptional vitamin profiles (Mooij et al, 1993) nor determinations of methylmalonic acid and homocysteine levels will detect all women at risk. Anencephaly and spina bifida can be identified prenatally by detection of excessive levels of alpha-fetoprotein in amniotic fluid and maternal serum and by ultrasonographic scanning (Wilson and Rudd, 1993). Both genetic counselling and prenatal diagnosis should be offered to women who are recognized to be at high risk. Research into the underlying biology of neural tube defects is of major importance. The identification of underlying genetic defects would allow for genetic testing and better counselling of families at risk for the occurrence of a neural tube defect.

The transport of vitamin C in the isolated human near-term placenta

We investigated the specific uptake (reference: [H3]-L-glucose) as a measure of membrane transfer of [C14]-labeled L-ascorbic acid (AA), L-dehydroascorbic acid (DHA) and diketogulonic acid using the single injection, double tracer dilution method in the artificially perfused lobe of the near-term human placenta. The uptake of DHA (40-60%) on both the fetal and the maternal side was 3-6 times higher than the uptake of AA, whereas an uptake of diketogulonic acid was not detected. AA transport was slightly higher on the maternal side. Uptake of DHA was suppressed by phloretin and cytocholasin B, whereas AA transfer was not affected. Low sodium concentrations inhibited the uptake of DHA. D-glucose (> 20 mmol/l) inhibited the DHA uptake, and DHA inhibited D-glucose uptake but not L-alanine uptake. The Km value (self inhibition) for DHA was 6-14 mmol/l. Vitamin C enters the trophoblast predominantly as L-dehydroascorbic acid. Its transfer through the microvillous and basal membrane might use the glucose transporter, however, a specific sodium-dependent pathway is not ruled out. Our transfer data suggest an intracellular pool of vitamin C which fills up with increasing plasma DHA-concentrations.

Pharmacokinetics and bioavailability of folic acid and plasma levels of bioactive folates after folic acid administration to pigs

After intravenous (1 mg/kg body weight), intramuscular (1 mg/kg body weight) and oral (1 and 50 mg/kg body weight) administration of folic acid (FA) to pigs, plasma levels of FA, tetrahydrofolic acid (THF), 5-methyltetrahydrofolic acid (5MF) were determined by using high-performance liquid chromatography. The pharmacokinetic profile of plasma FA after oral administration indicated an absorption rate-limited elimination, i.e., so called 'flip-flop' phenomenon. The bioavailability of FA was quite low after a high oral dose (F = 0.01), in contrast to a high value after intramuscular administration (F = 0.95). The plasma levels of biologically active, reduced forms of folates (THF and 5MF) were significantly increased over their basal levels after IV and IM administration to FA. The levels of these active folates were not increased after oral administration of a similar dose of FA. A 50 times higher dose was required to increase the active folates to the levels observed after IV and IM administration.

Disturbed reproductive performance in extreme folic acid deficient golden hamsters

We studied the effects of folic acid-deficient diets on maternal red blood cell folate level and reproductive performance in golden hamsters (Mesocricetus auratus, Waterhouse). Animals on the same day of oestrous cycle were put together and finally divided into three groups. Each group comprised at least 12 mature female hamsters. The animals were given three different diets, which were commenced before mating. The feeding regimens comprised a standard diet (group 1), or a folic acid-deficient diet which started either 2 weeks (group 2) or 16 weeks (group 3) prior to mating. The regimens were continued until sacrifice of the animals on day 9 of pregnancy. Pregnancy was realized by caging a male with a selected female during the night of ovulation. Just prior to sacrifice, blood samples were drawn to measure maternal folic acid levels in red blood cells. The pregnant uteri were removed and the embryonic sacs were carefully dissected away from the uterus. The number of sacs per pregnant animal was noted. Extreme folic acid deficiencies were confirmed in the pregnant golden hamsters on a folic acid-deficient diet which started 16 weeks prior to mating as compared to those on a standard diet and on a folic acid-deficient diet which started 2 weeks prior to mating. This deficiency appears to interfere with normal reproductive performance. It caused early embryonic loss several days after mating and resulted, finally, in restoration of the oestrous cycle.

Growth of 9.5-day rat embryos in folic-acid-deficient serum

Rat embryos (9.5-day-old) were cultured for 48 hours in serum from diet-induced folic-acid-deficient rats. Resultant embryos were frequently abnormal; many were growth retarded and exhibited a defect in the turning mechanism that inverts the embryo from ventrally to dorsally convex. Affected embryos displayed abnormal twisting or kinking of the neural tube. Gross anaemia was also frequently observed, and the protein content of the embryos was markedly less than that of embryos grown in normal rat serum. Supplementation of the deficient serum with folic acid improved growth and greatly reduced the occurrence of deformities. It virtually eliminated the incidence of gross anaemia but only partially restored the protein content of the embryos to the level observed in those grown in normal rat serum. The effects of the folate deficiency could be eliminated by supplementation with normal rat serum. The data indicate that embryos have a requirement for adequate folate in order for normal growth and differentiation to take place; they also suggest that some of the embryopathic effects of maternal folate deficiency are mediated by secondary effects on maternal metabolism. This may take the form of a disturbance in the production of maternally synthesised growth factors necessary for normal embryonic development.

Feeding children: in the beginning--nutrition and pregnancy

The health and well-being of every child is affected by both the quality and quantity of food, but when does nutrition first begin to be important? Is it after the birth or from the moment of conception, or perhaps even before this? This paper will focus on the nutritional status of the mother, before as well as during pregnancy, and its relationship to the birth weight and subsequent health of the child. Pre-pregnant weight is a major factor affecting birth weight; underweight women may be at increased risk of delivering a low birthweight infant and of complications of pregnancy, whilst those who are excessively obese are at greater risk of gestational diabetes and hypertension. Animal studies have demonstrated that severe vitamin and mineral deficiencies have dramatic effects on reproductive outcome, and there is now growing evidence that even marginal deficiencies in women may have deleterious effects on pregnancy outcome. Nutrition interventions which involve low-risk women appear to have little effect but beneficial effects have been demonstrated in interventions directed at high-risk women. Information about nutrition should be the mainstay of any advice given to prospective parents.