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Farrell CC, Khanna S, Hoque MT, Plaga A, Basset N, Syed I, Biouss G, Aufreiter S, Marcon N, Bendayan R, Kim YI, O'Connor DL. Low-dose daily folic acid (400 μg) supplementation does not affect regulation of folate transporters found present throughout the terminal ileum and colon of humans: a randomized clinical trial. Am J Clin Nutr 2024; 119:809-820. [PMID: 38157986 DOI: 10.1016/j.ajcnut.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Folic acid supplementation during the periconceptional period reduces the risk of neural tube defects in infants, but concern over chronic folic acid exposure remains. An improved understanding of folate absorption may clarify potential risks. Folate transporters have been characterized in the small intestine, but less so in the colon of healthy, free-living humans. The impact of folic acid fortification or supplementation on regulation of these transporters along the intestinal tract is unknown. OBJECTIVE The objective was to characterize expression of folate transporters/receptor (FT/R) and folate hydrolase, glutamate carboxypeptidase II (GCPII), from the terminal ileum and throughout the colon of adults and assess the impact of supplemental folic acid. METHODS In this 16-wk open-labeled randomized clinical trial, adults consumed a low folic acid-containing diet, a folate-free multivitamin, and either a 400 μg folic acid supplement or no folic acid supplement. Dietary intakes and blood were assessed at baseline, 8 wk, and 16 wk (time of colonoscopy). Messenger RNA (mRNA) expression and protein expression of FT/R and GCPII were assessed in the terminal ileum, cecum, and ascending and descending colon. RESULTS Among 24 randomly assigned subjects, no differences in dietary folate intake or blood folate were observed at baseline. Mean ± SD red blood cell folate at 16 wk was 1765 ± 426 and 911 ± 242 nmol/L in the 400 and 0 μg folic acid group, respectively (P < 0.0001). Reduced folate carrier, proton-coupled folate transporter, and folate-receptor alpha expression were detected in the terminal ileum and colon, as were efflux transporters of breast cancer resistance protein and multidrug resistance protein-3. Other than a higher mRNA expression of FR-alpha and GCPII in the 400 μg supplement group in the ascending colon, no treatment differences were observed (P < 0.02). CONCLUSIONS Folate transporters are present throughout the terminal ileum and colon; there is little evidence that a low dose of folic acid supplementation affects colonic absorption. This trial was registered at clinicaltrials.gov as NCT03421483.
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Affiliation(s)
- Colleen C Farrell
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Siya Khanna
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Md Tozammel Hoque
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Aneta Plaga
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nancy Basset
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ishba Syed
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - George Biouss
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susanne Aufreiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Reina Bendayan
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Young-In Kim
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Liu X, Liu X, An H, Li Z, Zhang L, Zhang Y, Liu J, Ye R, Li N. Folic acid supplements and perinatal mortality in China. Front Nutr 2024; 10:1281971. [PMID: 38260077 PMCID: PMC10800445 DOI: 10.3389/fnut.2023.1281971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Periconceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects. Methods From the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks' gestation and early neonatal deaths within 7 days of delivery. Results Among the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks' gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China. Conclusion Periconceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.
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Affiliation(s)
- Xiaojing Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Xiaowen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Hang An
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Le Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Yali Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Jianmeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Rongwei Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
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Chen L, Yang T, Wang T, Sun M, Qin J. Relationships between Maternal Folic Acid Supplementation and GATA4 Gene Polymorphisms in Patients with Non-Chromosomal Congenital Heart Disease: A Hospital-Based Case-Control Study in China. Nutrients 2023; 15:4478. [PMID: 37892553 PMCID: PMC10610291 DOI: 10.3390/nu15204478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to investigate the relationships between maternal FA supplementation and nine single-nucleotide variants of the GATA4 gene in non-chromosomal CHD and further explore the gene-environment interactions associated with CHD. A total of 585 CHD patients and 600 controls were recruited in the case-control study. Maternal FA (FA-containing multivitamin) supplementation information and nine polymorphisms of the GATA4 gene were collected in this study. Adjusted ORs (aOR) and their 95% confidence intervals (CIs) were calculated using proper statistical methods to analyze the relationships between the two main exposures of interest with respect to CHD. After adjusting the suspicious confounding factors, a significantly increased risk for CHD in offspring was found with non-FA supplementation before/during the pregnancy to CHD in offspring (aOR = 1.58, 95% CI: 1.01-2.48). We suggested taking FA supplementation before/during the pregnancy to prevent CHD in offspring, especially in the preconception period (aOR = 0.53, 95% CI: 0.32-0.90). The genetic results showed that the polymorphisms of rs4841588, rs12458, and rs904018 under specific genotypes and genetic models were significantly related to CHD. The gene-environment interaction between rs10108052 and FA supplementation before/during pregnancy could increase the risk of CHD (aOR = 5.38, 95% CI: 1.67-17.09, Pinteraction = 0.004). Relationships between maternal FA supplementation and specific polymorphisms of the GATA4 gene, as well as the gene-environment interaction, were significantly associated with CHD in offspring.
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Affiliation(s)
- Letao Chen
- Infection Control Center, Xiangya Hospital, Central South University, Changsha 410017, China;
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410017, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410017, China; (T.Y.); (M.S.)
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410017, China; (T.Y.); (M.S.)
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410017, China; (T.Y.); (M.S.)
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410017, China; (T.Y.); (M.S.)
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Petermann-Rocha F, Valera-Gran D, Prieto-Botella D, Martens DS, Gonzalez-Palacios S, Riaño-Galán I, Murcia M, Irizar A, Julvez J, Santa-Marina L, Tardón A, Sunyer J, Vioque J, Nawrot T, Navarrete-Muñoz EM. Folic Acid Supplementation during Pregnancy and Its Association with Telomere Length in Children at Four Years: Results from the INMA Birth Cohort Study. Nutrients 2023; 15:4303. [PMID: 37836587 PMCID: PMC10574547 DOI: 10.3390/nu15194303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/24/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
This study examined the association between folic acid supplements (FAs) during different periods of pregnancy and offspring telomere length (TL) at age four in 666 children from the INMA study. FAs were self-reported using food-structured questionnaires during three periods of pregnancy (the first three months of pregnancy, from month fourth onward, and the whole pregnancy). For each period, the average daily dosage of FAs was categorised into (i) <400 μg/d, (ii) ≥400 to 999 μg/d, (iii) ≥1000 to 4999 μg/d, and (iv) ≥5000 μg/d. Leucocyte TL at age four was measured using quantitative PCR methods. Multiple robust linear log-level regression models were used to report the % difference among FA categories. During the first period, and compared with children whose mothers were classified in the reference group (<400 μg/d), children whose mothers took higher dosages of FAs showed shorter TL at age four (≥5000 μg/d). When the first and the second periods were mutually adjusted, children whose mothers self-reported ≥5000 μg/d during the first period of pregnancy had a statistically significant shorter TL than their counterparts (% difference: -7.28% [95% CI: -14.42 to -0.13]). Similar trends were observed for the whole period of pregnancy. When the analysis was stratified by sex, the association was more evident in boys (% difference: -13.5% [95% CI: -23.0 to -4.04]), whereas no association was observed in girls. This study suggests that high dosages of FAs in the first pregnancy period may be associated with a shorter TL in children at age four, particularly among boys. Further studies should confirm these results.
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Affiliation(s)
- Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago 8370109, Chile;
| | - Desirée Valera-Gran
- Department of Surgery and Pathology, Miguel Hernandez University, 03550 Alicante, Spain; (D.P.-B.); (E.-M.N.-M.)
- Grupo de Investigación en Terapia Ocupacional (InTeO), Miguel Hernandez University, 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain; (S.G.-P.); (J.V.)
| | - Daniel Prieto-Botella
- Department of Surgery and Pathology, Miguel Hernandez University, 03550 Alicante, Spain; (D.P.-B.); (E.-M.N.-M.)
- Grupo de Investigación en Terapia Ocupacional (InTeO), Miguel Hernandez University, 03550 Alicante, Spain
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, 3590 Hasselt, Belgium; (D.S.M.)
| | - Sandra Gonzalez-Palacios
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain; (S.G.-P.); (J.V.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Isolina Riaño-Galán
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), University of Oviedo, 33003 Oviedo, Spain
- Pediatrics Unit, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Mario Murcia
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, 46020 Valencia, Spain
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana, 46010 Valencia, Spain
| | - Amaia Irizar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa, Spain
- Group of Environmental Epidemiology and Child Development, Biodonostia Health Institute, 20014 San Sebastian, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Clinical and Epidemiological Neuroscience Group (NeuroÈpia), Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Instituto de Salud Global (ISGlobal) de Barcelona Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain
| | - Loreto Santa-Marina
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Group of Environmental Epidemiology and Child Development, Biodonostia Health Institute, 20014 San Sebastian, Spain
- Health Department of Basque Government, Sub-Directorate of Public Health of Gipuzkoa, 20013 San Sebastian, Spain
| | - Adonina Tardón
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), University of Oviedo, 33003 Oviedo, Spain
- Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Departamento de Medicina, University of Oviedo, 33006 Oviedo, Spain
| | - Jordi Sunyer
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Instituto de Salud Global (ISGlobal) de Barcelona Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Jesús Vioque
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain; (S.G.-P.); (J.V.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (I.R.-G.); (M.M.); (A.I.); (J.J.); (L.S.-M.); (A.T.); (J.S.)
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, 3590 Hasselt, Belgium; (D.S.M.)
| | - Eva-María Navarrete-Muñoz
- Department of Surgery and Pathology, Miguel Hernandez University, 03550 Alicante, Spain; (D.P.-B.); (E.-M.N.-M.)
- Grupo de Investigación en Terapia Ocupacional (InTeO), Miguel Hernandez University, 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain; (S.G.-P.); (J.V.)
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Bokayeva K, Jamka M, Banaszak M, Makarewicz-Bukowska A, Adamczak A, Chrobot M, Janicka A, Jaworska N, Walkowiak J. The Effect of Folic Acid Supplementation on Endothelial Function and Arterial Stiffness Markers in Adults: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2524. [PMID: 37761721 PMCID: PMC10531078 DOI: 10.3390/healthcare11182524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Folic acid might improve endothelial function, but the results are inconclusive. This systematic review evaluated the effect of folic acid supplementation on endothelial parameters and arterial stiffness in adults. The study protocol was registered with the PROSPERO database (CRD42021290195). The PubMed, Web of Sciences, Cochrane and Scopus databases were searched to identify English-language randomised controlled trials of the effect of folate supplementation on arterial stiffness and endothelial function markers in adults. There were significant differences between the effect of folic acid and placebo on flow-mediated dilation (random-effects model, standardized mean differences (SMD): 0.888, 95% confidence interval (CI): 0.447, 1.329, p < 0.001) and monocyte chemotactic protein 1 (random-effects model, SMD: -1.364, 95% CI: -2.164, -0.563, p < 0.001), but there was no significant difference in the central pulse wave velocity (fixed-effects model, SMD: -0.069, 95% CI: -0.264, 0.125, p = 0.485) and peripheral pulse wave velocity (fixed-effects model, SMD: -0.093, 95% CI: -0.263, 0.077, p = 0.284). In conclusion, folic acid might have a favourable effect on endothelial function but may not affect arterial stiffness. Further studies are needed to confirm these results.
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Affiliation(s)
- Kamila Bokayeva
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Małgorzata Jamka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Michalina Banaszak
- Department of Bromatology, Poznan University of Medical Sciences, Rokietnicka Str. 3, 60-806 Poznań, Poland;
| | - Aleksandra Makarewicz-Bukowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Ada Adamczak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Maria Chrobot
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Adrianna Janicka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Natalia Jaworska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (A.M.-B.); (A.A.); (M.C.); (A.J.); (N.J.)
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Liu H, Ou J, Chen Y, Chen Q, Luo M, Wang T, Qin J. Association of Maternal Folate Intake and Offspring MTHFD1 and MTHFD2 Genes with Congenital Heart Disease. Nutrients 2023; 15:3502. [PMID: 37630697 PMCID: PMC10458540 DOI: 10.3390/nu15163502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Existing evidence supported that congenital heart defect (CHD) was associated with a combination of environmental and genetic factors. Based on this, this study aimed at assessing the association of maternal folic acid supplementation (FAS), genetic variations in offspring methylenetetrahydrofolate dehydrogenase (MTHFD)1 and MTHFD2 genes, and their interactions with CHD and its subtypes. A hospital-based case-control study, including 620 cases with CHD and 620 healthy children, was conducted. This study showed that the absence of FAS was significantly associated with an increased risk of total CHD and its subtypes, such as atrial septal defect (ASD). FAS during the first and second trimesters was associated with a significantly higher risk of CHD in offspring compared to FAS during the three months prior to conception. The polymorphisms of offspring MTHFD1 and MTHFD2 genes at rs2236222, rs11849530, and rs828858 were significantly associated with the risk of CHD. Additionally, a significantly positive interaction between maternal FAS and genetic variation at rs828858 was observed for the risk of CHD. These findings suggested that pregnant women should carefully consider the timing of FAS, and individuals with higher genetic risk may benefit from targeted folic acid supplementation as a preventive measure against CHD.
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Affiliation(s)
- Hanjun Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Jun Ou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Yige Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Qian Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Manjun Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; (H.L.); (J.O.); (Y.C.); (Q.C.); (M.L.)
- National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410028, China
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Pal A, Shukla AK, Santra A, Galhotra A, Thakur P, Patel S, Singh S, Rajbhar S. Awareness About Folic Acid Supplementation in First-Trimester Pregnant Women of Rural Raipur District, Chhattisgarh, and Its Determinants: A Cross-Sectional Study. Cureus 2023; 15:e40583. [PMID: 37469820 PMCID: PMC10352862 DOI: 10.7759/cureus.40583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Women are supplemented with folic acid (FA) during pregnancy as well as preconceptionally to prevent neural tube defects (NTDs) in newborns. To understand the importance of FA supplementation, women need to have awareness about the same, which in turn may be influenced by different factors. It is also known that both FA and vitamin B12 deficiency tend to cause NTDs in newborns and anemia. Very few studies have studied the relationship between hemoglobin, FA, and vitamin B12 levels. In this study, we aim to estimate the level of awareness of FA supplementation among pregnant women in the first trimester of pregnancy and the factors determining the presence of awareness regarding the same. Also, we aim to estimate any correlation between hemoglobin, FA, and vitamin B12 levels among a subset of pregnant women. METHODS A cross-sectional study was conducted in the Abhanpur Block of Raipur district in Chhattisgarh among 399 pregnant women in their first trimester of pregnancy, in which their knowledge was assessed using a pretested semistructured questionnaire. Each participant's knowledge score regarding FA supplementation was calculated and scored based on six indicators and classified as low, intermediate, and high scores. Logistic regression was applied to find out any significant association between knowledge about FA supplementation with any other sociodemographic variables. Scatter plots were used to assess the correlation of FA with hemoglobin, vitamin B12, and knowledge scores among 104 participants. RESULTS The majority (77.9%) of women had low knowledge scores with a mean score of 1.4 (0.15). It was found that only 45.6% of the participants knew the importance of FA supplementation, and the majority (23.1%) were informed by auxiliary nurse midwives (ANMs) followed by doctors. The majority (41.6%) of the study participants also did not know when to start FA, and only 1.3% knew that FA should be taken preconceptionally. On multivariable logistic regression, women who lived in joint families had significantly higher odds of having intermediate knowledge compared to those who lived in nuclear families. Although not statistically significant, there was a positive correlation between serum vitamin B12 and FA levels and also between hemoglobin and serum FA levels. However, a significant positive correlation was found between serum FA levels and the knowledge scores of the study participants. CONCLUSION The majority of study participants had poor knowledge and awareness regarding FA supplementation. So, health education, as well as information, education, and communication (IEC) activities, is required to improve the knowledge about FA supplementation among women of reproductive age in the community. A better understanding of FA supplementation can lead to adherence to FA consumption and prevent NTDs among newborns.
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Affiliation(s)
- Anjali Pal
- Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Arvind K Shukla
- Community and Family Medicine/Biostatistics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Archismita Santra
- Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Abhiruchi Galhotra
- Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pushpawati Thakur
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Suprava Patel
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sunita Singh
- Pediatric Surgery, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Sarita Rajbhar
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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8
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Zhu L, Zhou Y, Fu Y, Sun W, Chen J, Yu N, Zhao M. Association of Folic Acid Supplementation, Dietary Folate Intake and Serum Folate Levels with Risk of Gestational Diabetes Mellitus: A Matched Case-Control Study. J Nutr Sci Vitaminol (Tokyo) 2023; 69:28-37. [PMID: 36858538 DOI: 10.3177/jnsv.69.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Periconceptional folate supplementation is prevalent, raising concerns about possible side effects. The aim of this study was to investigate the associations of folic acid supplementation, dietary folate, serum folate with gestational diabetes mellitus (GDM) risk. In this matched case-control study, 81 pregnant women with GDM (cases) and 81 pregnant women with non-GDM (controls) were identified through age difference (≤3 y) and parity (Both primipara or multipara women) matching, and serum folate levels were measured during the GDM screening (24-28 gestational wk). Folic acid supplementation and dietary folate intake from three months prepregnancy through midpregnancy were assessed using a self-reported questionnaire and food frequency questionnaire. Multivariate binary logistic regression models were used to evaluate the association between folate and GDM. After adjusting for confounding factors, we observed that compared with folic acid supplementation dose ≤400 μg/d, pregnancies without folic acid supplementation and supplemental dose >800 μg/d were associated with GDM risk (adjusted odds ratio=7.25, 95% confidence interval: 1.34-39.36; adjusted odds ratio=4.20, 95% confidence interval: 1.03-17.22), while no significant association with a 400-800 μg/d dose of folic acid supplementation and GDM. Compared with folic acid supplementation dose ≤24 wk, pregnancies without folic acid supplementation were associated with GDM risk (adjusted odds ratio=6.70, 95% confidence interval: 1.22-36.77), while no significant association with folic acid supplementation dose >24 wk and GDM. No significant association of dietary folate and serum folate with GDM was found. No or a higher dose of folic acid supplementation would increase GDM risk and a dose of <800 μg/d is the safe dose.
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Affiliation(s)
- Liyuan Zhu
- School of Nursing, Anhui Medical University
| | - Ya Zhou
- Medical School, Anhui University of Science and Technology
| | - Yueqi Fu
- School of Nursing, Anhui Medical University
| | | | - Jing Chen
- School of Nursing, Anhui Medical University
| | | | - Mei Zhao
- School of Nursing, Anhui Medical University
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9
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Karaçil Ermumcu MŞ, Acar Tek N. Effects of High-dose Folic Acid Supplementation on Maternal/Child Health Outcomes: Gestational Diabetes Mellitus in Pregnancy and Insulin Resistance in Offspring. Can J Diabetes 2023; 47:133-142. [PMID: 36411183 DOI: 10.1016/j.jcjd.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of maternal high folic acid (FA) supplementation during pregnancy on glucose intolerance in dams and insulin resistance in offspring. METHODS Wistar female rats (n=18) were mated and randomly divided into 3 groups: a control group and 2 experimental groups. Three different feeding protocols were administered during pregnancy: control group, 2 mg/kg FA (recommended level FA supplementation); experimental 1 group, 5 mg/kg FA (tolerable upper intake level of FA supplementation [ULFolS]); and experimental 2 group, 40 mg/kg FA (high FA supplementation [HfolS]). All dams were fed the same FA content diet (2 mg/kg FA) during the lactation period. An oral glucose tolerance test was performed on day 16 of pregnancy. After the lactation period, body weight and food intake of 36 pups were monitored. Dams were euthanized at the end of the lactation period and half of the pups were euthanized at the end of week 7 and the others at the end of week 12. Serum FA, homocysteine, vitamin B12, insulin, glucose, interleukin-6, tumor necrosis factor-alpha, glycated hemoglobin (A1C), and adiponectin levels of mothers and pups were evaluated. The homeostatic model of insulin resistance (HOMA-IR) was used to determine insulin resistance in dams and offspring. RESULTS According to glucose tolerance test results of dams, blood glucose values at minutes 0, 60, 90, and 120 for the HFolS group were significantly higher compared with the control group (p<0.05). The A1C level in HFolS dams was significantly higher than in the control group (p<0.05). The mean birthweight of the pups in the HFolS group was significantly higher than that of control pups (p<0.05). HOMA-IR values for control and HFolS offspring were similar at weeks 7 and 12 and higher than in ULFolS offspring (p>0.05). CONCLUSIONS It was determined that high doses of FA exposure during pregnancy might be effective in the development of glucose intolerance in dams and insulin resistance in offspring in this study.
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Affiliation(s)
| | - Nilüfer Acar Tek
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
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10
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Zhang YJ, Jiang H, Lu C, Sun Y, Cui S, Chen C. The interaction between no folic acid supplementation during early pregnancy and preeclampsia increased the risk of preterm birth. Saudi Med J 2023; 44:260-267. [PMID: 36940967 PMCID: PMC10043892 DOI: 10.15537/smj.2023.44.3.20220695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/18/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES To explore if there is a positive additive interaction between no folic acid (FA) supplementation in early period of pregnancy and preeclampsia which increases the risk of preterm birth (PTB). METHODS We matched 1471 women who had live-birth singleton preterm infants with 1471 women who had live-birth singleton term infants at 15 Chinese hospitals in 2018. We excluded women who took folic acid less than 0.4 mg/d or less than 12 weeks in early stage, women with gestational hypertension, chronic hypertension, or preeclampsia during previous pregnancy. We calculate odds ratios for PTB by performing conditional logistic regression comparing preterm group with term group.We quantified the interaction between 2 exposures by synergy (S) and relative excess risk due to interaction (RERI). RESULTS Approximately 40% of preterm cases did not take FA in early pregnancy. After adjusting confounding factors by logistic regression, when the 2 exposures (no early FA supplementation and preeclampsia) co-existed, the risk of all PTB increased significantly (aOR11=12.138; 95% CI 5.726-25.73), the interaction between 2 exposures was positive (S=1.27) and increased 2.385-fold risk of all PTB (RERI=2.385); and there were similar results on iatrogenic PTB (aOR11=23.412; 95% CI 8.882-60.71, S=1.18, RERI=3.347). CONCLUSION Our multicenter study showed, for the first time, that there was a positive additive interaction between no FA supplementation in early pregnancy and preeclampsia which increased the risk of all PTB, especially iatrogenic PTB.
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Affiliation(s)
- Yi-Jie Zhang
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
| | - Hong Jiang
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
| | - Chengqiu Lu
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
| | - Yi Sun
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
| | - Shudong Cui
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
| | - Chao Chen
- From the Department of Neonatology (Zhang, Jiang), Affiliated Hospital of Qingdao University, Qingdao; from the Department of Neonatology (Chen), Children’s Hospital of Fudan University; from the Division of Neonatology (Lu), Gynecology and Obstetrics Hospital of Fudan University, Shanghai; from the Department of Neonatology (Sun), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou; from the Department of Neonatology (Cui), First Affiliated Hospital Nanjing Medical University, Nanjing, Chin.
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11
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Yang J, Reheman Z, Liu Y, Wang Y, Wang N, Ye J, Li Y, Nie J. The compliance of free folic acid supplements among pregnant women in rural areas of Northwestern China: The role of related knowledge. Front Public Health 2023; 10:1079779. [PMID: 36699923 PMCID: PMC9868550 DOI: 10.3389/fpubh.2022.1079779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Background High prevalence of neural tube defects remains one of the major threats to newborns in rural China. Folic acid supplementation before and during early pregnancy can effectively reduce the risk of neural tube defects. Despite the efforts of the free folic acid mass distribution, the actual usage of folic acid supplements was still suboptimal among rural pregnant women in China. The objective of this study is to investigate if and how knowledge can influence the picking up and intake of the free folic acid supplements distributed by the government. Methods We collected survey data from 821 pregnant women in rural areas of Shaanxi, China, in March and December of 2021. Face-to-face interviews and questionnaire surveys were conducted with every participant. Univariate and multivariate logistic regression analyses were performed to test the relationship between knowledge and dependent variables. Results Our study found that there were 76.4% of pregnant women would pick up folic acid supplements distributed by the government and only 44.5% of women would use folic acid before current pregnancy. Awareness of folic acid policy both affects the picking up (OR: 6.708, 95% CI: 4.672-9.632) and periconceptional intake (OR: 1.912, 95% CI:1.326-2.758) of folic acid supplements. Knowledge of health and nutrition in pregnancy showed no significant relationship with the picking up and periconceptional intake of folic acid supplements but was positively associated with the intake duration (Coefficient: 9.278, 95% CI: 2.966-15.591). Conclusion Despite the relatively high level of picking up, the actual folic acid usage was not ideal among pregnant women in rural areas of China. Folic acid policy awareness was positively associated with the picking up and intake of folic acid before and during conception. Knowledge of health and nutrition about pregnancy was related to a longer duration of folic acid intake but had no impact on the picking up rate and periconceptional intake of folic acid supplements.
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Affiliation(s)
- Jie Yang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Zulihumaer Reheman
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Yunjie Liu
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Yuan Wang
- Management, Strategy, and Entrepreneurship Department, College of Business, University of Houston-Victoria, Victoria, TX, United States
| | - Nan Wang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Jinbiao Ye
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Yangyuan Li
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Jingchun Nie
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
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12
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Ihirwe RG, Martel J, Rahimi S, Trasler J. Protective and sex-specific effects of moderate dose folic acid supplementation on the placenta following assisted reproduction in mice. FASEB J 2023; 37:e22677. [PMID: 36515682 PMCID: PMC10108070 DOI: 10.1096/fj.202201428r] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
Epigenetic defects induced by assisted reproductive technologies (ART) have been suggested as a potential mechanism contributing to suboptimal placentation. Here, we hypothesize that ART perturbs DNA methylation (DNAme) and gene expression during early placenta development, leading to abnormal placental phenotypes observed at term. Since folic acid (FA) plays a crucial role in epigenetic regulation, we propose that FA supplementation can rescue ART-induced placental defects. Female mice were placed on a control diet (CD), a moderate 4-fold (FAS4) or high dose 10-fold (FAS10) FA-supplemented diet prior to ART and compared to a natural mating group. ART resulted in 41 and 28 differentially expressed genes (DEGs) in E10.5 female and male placentas, respectively. Many DEGs were implicated in early placenta development and associated with DNAme changes; a number clustered at known imprinting control regions (ICR). In females, FAS4 partially corrected alterations in gene expression while FAS10 showed evidence of male-biased adverse effects. DNAme and gene expression for five genes involved in early placentation (Phlda2, EphB2, Igf2, Peg3, L3mbtl1) were followed up in placentas from normal as well as delayed and abnormal embryos. Phlda2 and Igf2 expression levels were lowest after ART in placentas of female delayed embryos. Moreover, ART concomitantly reduced DNAme at the Kcnq1ot1 ICR which regulates Phlda2 expression; FAS4 partially improved DNAme in a sex-specific manner. In conclusion, ART-associated placental DNAme and transcriptome alterations observed at mid-gestation are sex-specific; they may help explain adverse placental phenotypes detected at term and are partially corrected by maternal moderate dose FA supplementation.
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Affiliation(s)
- Rita Gloria Ihirwe
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Josée Martel
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sophia Rahimi
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jacquetta Trasler
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
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13
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Yang L, Wang W, Mao B, Qiu J, Guo H, Yi B, He X, Lin X, Lv L, Xu X, Liu Q, Cao Y, Chen Y. Maternal Folic Acid Supplementation, Dietary Folate Intake, and Low Birth Weight: A Birth Cohort Study. Front Public Health 2022; 10:844150. [PMID: 35757618 PMCID: PMC9218084 DOI: 10.3389/fpubh.2022.844150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To investigate the independent and collective effects of maternal folic acid supplementation or dietary folate intake on the risk of low birth weight (LBW), and to further comprehensively examine the joint associations of folic acid supplementation and dietary folate intake with LBW by various clinical subtypes. Design Participants were recruited from Gansu Provincial Maternity and Child Care Hospital. A standardized and structured questionnaire was distributed to collect demographic factors, reproductive and medical history, occupational and residential history, physical activity, and diet. Data on pregnancy-related complications and birth outcomes were extracted from medical records. Unconditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for single and joint associations of folic acid supplementation and dietary folate intake with LBW. Setting A birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. Participants In total, 9,231 pregnant women and their children were enrolled in the study. Results Compared with non-users, folic acid supplementation was associated with a reduced risk of LBW (OR: 0.80, 95% CI: 0.66–0.97), and the reduced risk was mainly seen for term-LBW (OR: 0.59, 95% CI: 0.41–0.85), and multiparous-LBW (OR: 0.72, 95% CI: 0.54–0.94). There were no significant associations between dietary folate intake and LBW, and there was no interaction between folic acid supplement and dietary folate intake on LBW. Conclusions Our study results indicated that folic acid supplementation was associated with a reduced risk of LBW, and there was no interaction between folic acid supplements and dietary folate intake on LBW.
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Affiliation(s)
- Liping Yang
- Department of Public Health and Infection Management, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Wenjuan Wang
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Baohong Mao
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Jie Qiu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Huaqi Guo
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Yi
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaochun He
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaojuan Lin
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Ling Lv
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaoying Xu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Qing Liu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Yongchun Cao
- Department of Operation Management, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Yiming Chen
- Department of Human Resource, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
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14
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Ye F, Zhang S, Qi Q, Zhou J, Du Y, Wang L. Association of MTHFR 677C>T polymorphism with pregnancy outcomes in IVF/ICSI-ET recipients with adequate synthetic folic acid supplementation. Biosci Trends 2022; 16:282-290. [PMID: 35691911 DOI: 10.5582/bst.2021.01306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphism rs1801133 (677C>T) will decrease the utilization of folate. Folate deficiency and its resulting homocysteine (HCY) accumulation can impair female fertility. Folic acid (FA) supplementation is necessary in pregnant women who are undergoing in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) - embryo transfer (ET), and especially in women with MTHFR rs1801133 C-to-T mutations. At present, affordable and accessible synthetic FA is mainly used. However, some studies have suggested that 5-methylenetetrahydrofolate (5-MTHF), a type of active FA, may be more suitable for women with the MTHFR 677C>T polymorphism, since it is safer and more effective. This retrospective study aimed to evaluate whether the MTHFR rs1801133 gene polymorphism is related to the pregnancy outcomes of IVF/ICSI-ET recipients after sufficient supplementation with FA instead of 5-MTHF. Data on 692 women undergoing IVF/ICSI-ET and taking adequate FA were collected. Participant characteristics were compared using the Kruskal-Wallis test and Pearson chi-square test. Logistic regressions were used to calculate the odds ratio (OR) and 95% confidence interval (95% CI), after adjusting for age, BMI, method of fertilization, method of embryo transfer and number of embryos transferred. An additive model (T/T vs. C/C), dominant model (C/T + T/T vs. C/C), and recessive model (T/T vs. C/T + C/C) were evaluated. Analysis revealed that MTHFR rs1801133 in IVF/ICSI-ET women with adequate FA supplementation was not associated with the pregnancy rate but with age (OR = 0.91, 95% CI = 0.88, 0.94, P < 0.001) and BMI (OR = 0.95, 95% CI = 0.90, 0.997, P = 0.037). In 349 clinically pregnant women, no association of the MTHFR 677C>T with pregnancy outcomes was found in the additive model, dominant model, or recessive model. Of the 273 women with positive pregnancy outcomes, 34 had a preterm delivery. MTHFR 677C>T was not associated with a preterm delivery after adjusting for age and BMI. The current results indicated that MTHFR polymorphism rs1801133 was not related to the pregnancy rate or pregnancy outcomes of women undergoing IVF/ICSI-ET with adequate synthetic FA supplementation, suggesting that simple supplementation with less expensive and readily available FA, rather than expensive 5-MTHF, appeared to be appropriate.
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Affiliation(s)
- Feijun Ye
- Reproductive Medicine Center, Zhoushan Maternal and Child Health Care Hospital, Zhoushan, Zhejiang, China
| | - Siwei Zhang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Qing Qi
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Yan Du
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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15
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Cueto HT, Jacobsen BH, Laursen ASD, Riis AH, Hatch EE, Wise LA, Trolle E, Sørensen HT, Rothman KJ, Wesselink AK, Willis S, Johannesen BR, Mikkelsen EM. Dietary folate intake and fecundability in two preconception cohorts. Hum Reprod 2022; 37:828-837. [PMID: 35051293 PMCID: PMC8971647 DOI: 10.1093/humrep/deac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/28/2021] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION To what extent is dietary folate intake and total folate intake (dietary and supplemental intakes) associated with fecundability, the per cycle probability of conception? SUMMARY ANSWER Preconception dietary folate intake was positively associated with fecundability in a monotonic pattern. WHAT IS KNOWN ALREADY Supplemental folic acid has been associated with improved fertility, but little is known about the relation between dietary folate and fecundability. STUDY DESIGN, SIZE, DURATION A prospective cohort study including 9559 women trying to conceive without fertility treatment and enrolled in the period 2013-2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We used data from two internet-based prospective cohort studies of pregnancy planners from Denmark, where folic acid fortification is not performed (SnartForældre.dk (SF); n = 3755) and North America, where the food supply is fortified with folic acid (Pregnancy Study Online (PRESTO); n = 5804). Women contributed menstrual cycles at risk until they reported conception or experienced a censoring event. We used proportional probabilities regression models to compute fecundability ratios (FRs) and 95% CI, adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE Compared with a dietary folate intake ≥400 µg/day, the adjusted FRs for women in SF were 0.92 (95% CI: 0.85-0.99) for intake 250-399 µg/day, and 0.80 (95% CI: 0.68-0.94) for intake of <250 µg/day. The corresponding FRs in PRESTO were 0.95 (95% CI: 0.89-1.01) and 0.81 (95% CI: 0.65-1.00). Compared with the highest level of total folate intake (diet folate ≥400 µg/day plus folic acid supplementation), in both cohorts fecundability was lowest among women with the lowest dietary intake <250 µg/day dietary folate and no supplementation (FR: 0.76, 95% CI: 0.59-0.98 [SF] and 0.49, 95% CI: 0.31-0.77 [PRESTO]). Further, total intake dietary folate <250 µg/day plus supplementation was associated with reduced fecundability for SF participants (FR; 0.79, 95% CI: 0.65-0.98) and for PRESTO participants (FR; 0.92, 95% CI: 0.72-1.16). LIMITATIONS, REASONS FOR CAUTION It is unknown whether dietary folate and folic acid intake affect fecundability on its own or if there is an interaction with other micronutrients provided in healthy diet. Thus, the observed associations may not reflect dietary folate intake alone, but overall healthy diet. WIDER IMPLICATIONS OF THE FINDINGS Recommendations for preconception dietary folate intake and folic acid supplementation are of importance not only to prevent neural tube defects but also to enhance fecundability. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the National Institute of Child Health and Human Development (R01-HD086742). The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Heidi T Cueto
- The Danish Clinical Quality Program and National Clinical Registries (RKKP), Aarhus, Denmark,Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anders H Riis
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ellen Trolle
- National Food Institute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA,RTI International, Research Triangle Park, NC, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sydney Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin R Johannesen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark,Correspondence address. Department of Clinical Epidemiology, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. E-mail: https://orcid.org/0000-0003-0158-7950
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Ashok T, Puttam H, Tarnate VCA, Jhaveri S, Avanthika C, Trejo Treviño AG, Sl S, Ahmed NT. Role of Vitamin B12 and Folate in Metabolic Syndrome. Cureus 2021; 13:e18521. [PMID: 34754676 PMCID: PMC8569690 DOI: 10.7759/cureus.18521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
Metabolic syndrome (MS) is a collection of pathological metabolic conditions that includes insulin resistance, central or abdominal obesity, dyslipidemia, and hypertension. It affects large populations worldwide, and its prevalence is rising exponentially. There is no specific mechanism that leads to the development of MS. Proposed hypotheses range from visceral adiposity being a key factor to an increase in very-low-density lipoprotein and fatty acid synthesis as the primary cause of MS. Numerous pharmaceutical therapies are widely available in the market for the treatment of the individual components of MS. The relationship between MS and vitamin B complex supplementation, specifically folic acid and vitamin B12, has been a subject of investigation worldwide, with several trials reporting a positive impact with vitamin supplementation on MS. In this study, an all-language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till September 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: “Vitamin B12,” “Folate,” “Metabolic Syndrome,” and “Insulin Resistance.” We explored the literature on MS for its epidemiology, pathophysiology, newer treatment options, with a special focus on the effectiveness of supplementation with vitamins B9 and B12. According to the literature, vitamin B12 and folate supplementation, along with a host of novel therapies, has a considerable positive impact on MS. These findings must be kept in mind while designing newer treatment protocols in the future.
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Affiliation(s)
- Tejaswini Ashok
- Internal Medicine, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, IND
| | - Harivarsha Puttam
- Internal Medicine, Employees' State Insurance Corporation Medical College and Hospital, Hyderabad, IND
| | | | - Sharan Jhaveri
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Chaithanya Avanthika
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND.,Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | | | - Sandeep Sl
- Internal Medicine, SRM Medical College Hospital & Research Centre, Kattankulathur, IND
| | - Nazia T Ahmed
- Medicine, Shahabuddin Medical College and Hospital, Dhaka, BGD
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17
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Fadila, Suman P, Kumar P, Omair F. Clinical Relevance of Methylenetetrahydrofolate Reductase Genetic Testing in Autism: A Case Report of Successful Clinical Outcome. Cureus 2021; 13:e12586. [PMID: 33577628 PMCID: PMC7870120 DOI: 10.7759/cureus.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder is an emerging public health issue. The core features of autism spectrum disorder are persistent impairment in reciprocal social communication and interaction and restricted, repetitive patterns of behavior or interests. We now know that it encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner autism, high-functioning autism, atypical autism, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. While it is agreed that the etiology of autism spectrum disorder is largely unknown, certain environmental and genetic factors may be responsible for the disease. In particular, emerging evidence has suggested the role of C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene as a possible risk factor. We present the case of a two-year-old boy with high risk for autism who was found on advanced investigation to have heterozygous polymorphism for MTHFR. This prompted us to add folic acid to his therapeutic regime. He was treated with high-dose folic acid along with conventional intervention, and went on to make excellent recovery. We conclude that pharmacological intervention has the potential to improve outcome in a subgroup of autistic children.
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Affiliation(s)
- Fadila
- Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, IND
| | - Praveen Suman
- Child Development Clinic, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, IND
| | - Praveen Kumar
- Division of Pediatric Neurology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, IND
| | - Faraz Omair
- Department of General Medicine, GreenLife Hospital, Patna, IND
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18
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Rahimi S, Martel J, Karahan G, Angle C, Behan NA, Chan D, MacFarlane AJ, Trasler JM. Moderate maternal folic acid supplementation ameliorates adverse embryonic and epigenetic outcomes associated with assisted reproduction in a mouse model. Hum Reprod 2020; 34:851-862. [PMID: 30989206 DOI: 10.1093/humrep/dez036] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/14/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Could clinically-relevant moderate and/or high dose maternal folic acid supplementation prevent aberrant developmental and epigenetic outcomes associated with assisted reproductive technologies (ART)? SUMMARY ANSWER Our results demonstrate dose-dependent and sex-specific effects of folic acid supplementation in ART and provide evidence that moderate dose supplements may be optimal for both sexes. WHAT IS KNOWN ALREADY Children conceived using ART are at an increased risk for growth and genomic imprinting disorders, often associated with DNA methylation defects. Folic acid supplementation is recommended during pregnancy to prevent adverse offspring outcomes; however, the effects of folic acid supplementation in ART remain unclear. STUDY DESIGN, SIZE, DURATION Outbred female mice were fed three folic acid-supplemented diets, control (rodent daily recommended intake or DRI; CD), moderate (4-fold DRI; 4FASD) or high (10-fold DRI; 10FASD) dose, for six weeks prior to ART and throughout gestation. Mouse ART involved a combination of superovulation, in vitro fertilisation, embryo culture and embryo transfer. PARTICIPANTS/MATERIALS, SETTING, METHODS Midgestation embryos and placentas (n = 74-99/group) were collected; embryos were assessed for developmental delay and gross morphological abnormalities and embryos and placentas were examined for epigenetic defects. We assessed methylation at four imprinted genes (Snrpn, Kcnq1ot1, Peg1 and H19) in matched midgestation embryos and placentas (n = 31-32/group) using bisulfite pyrosequencing. In addition, we examined genome-wide DNA methylation patterns in placentas (n = 6 normal placentas per sex/group) and embryos (n = 6 normal female embryos/group; n = 3 delayed female embryos/group) using reduced representation bisulfite sequencing (RRBS). MAIN RESULTS AND THE ROLE OF CHANCE Moderate, but not high dose supplementation, was associated with a decrease in the proportion of developmentally delayed embryos. Although moderate dose folic acid supplementation reduced DNA methylation variance at certain imprinted genes in embryonic and placental tissues, high dose supplementation exacerbated the negative effects of ART at imprinted loci. Furthermore, folic acid supplements resolved female-biased aberrant imprinted gene methylation. Supplementation was more effective at correcting ART-induced genome-wide methylation defects in male versus female placentas; however, folic acid supplementation also led to additional methylation perturbations which were more pronounced in males. LARGE-SCALE DATA The RRBS data from this study have been submitted to the NCBI Gene Expression Omnibus under the accession number GSE123143. LIMITATIONS REASONS FOR CAUTION Although the combination of mouse ART utilised in this study consisted of techniques commonly used in human fertility clinics, there may be species differences. Therefore, human studies, designed to determine the optimal levels of folic acid supplementation for ART pregnancies, and taking into account foetal sex, are warranted. WIDER IMPLICATIONS OF THE FINDINGS Taken together, our findings support moderation in the dose of folic acid supplements taken during ART. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Canadian Institutes of Health Research (FDN-148425). The authors declare no conflict of interest.
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Affiliation(s)
- Sophia Rahimi
- Child Health and Human Development Program (CHHD), Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montréal QC, Canada.,Department of Human Genetics, McGill University, 3640 rue University, Montréal QC, Canada
| | - Josée Martel
- Child Health and Human Development Program (CHHD), Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montréal QC, Canada
| | - Gurbet Karahan
- Child Health and Human Development Program (CHHD), Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montréal QC, Canada.,Department of Human Genetics, McGill University, 3640 rue University, Montréal QC, Canada
| | - Camille Angle
- Department of Pharmacology and Therapeutics, McGill University, 3655 Promenade Sir William Osler, Montréal QC, Canada
| | - Nathalie A Behan
- Nutrition Research Division, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa ON, Canada
| | - Donovan Chan
- Child Health and Human Development Program (CHHD), Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montréal QC, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa ON, Canada
| | - Jacquetta M Trasler
- Child Health and Human Development Program (CHHD), Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montréal QC, Canada.,Department of Human Genetics, McGill University, 3640 rue University, Montréal QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, 3655 Promenade Sir William Osler, Montréal QC, Canada.,Department of Pediatrics, McGill University, 1001 Décarie Boulevard, Montréal QC, Canada
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19
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Wegner C, Kancherla V, Lux A, Köhn A, Bretschneider D, Freese K, Heiduk M, Redlich A, Schleef D, Jorch G, Rissmann A. Periconceptional folic acid supplement use among women of reproductive age and its determinants in central rural Germany: Results from a cross sectional study. Birth Defects Res 2020; 112:1057-1066. [PMID: 32445297 DOI: 10.1002/bdr2.1714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prevalence of neural tube defects (NTD) has not decreased in Germany despite longstanding recommendations for folic acid supplementation. To examine the prevalence of periconceptional folic acid supplement use and associated factors among German women of reproductive age. METHODS Cross-sectional survey was conducted in hospital-based maternity units in rural Germany. A sample of 1,004 women of reproductive age, either pregnant or in their early postpartum period, took interviewer/self-administered paper-based survey questionnaire. Prevalence of periconceptional folic acid supplement use was assessed, where periconception was defined as 1 month prior to and 3 months post-conception. Prevalence odds ratios (POR) and 95% confidence intervals (CI) using crude and adjusted logistic regression analysis were estimated to examine determinants of folic acid supplement use. RESULTS Prevalence of folic acid supplement use was 41.5% (95% CI: 37.7%, 45.7%). Multivariable analysis showed lack of educational qualifications, unplanned pregnancy, later diagnosis of pregnancy, increased parity, and not having an awareness of importance of folic acid for optimal pregnancy outcomes were associated with not taking periconceptional folic acid supplements. Books, doctors, friends, media, were sources of information. CONCLUSION Periconceptional folic acid is sub-optimal in rural Germany and thus failing to prevent NTDs. Targeted promotion of folic acid supplement use should be conducted periodically by gynecologists and primary care physicians during annual medical screenings. Mandatory folic acid fortification of staple foods is a complementary approach to overcome limitations of individual behaviors of folic acid supplement intake, and should be considered as it has been proven effective in multiple countries.
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Affiliation(s)
- Clara Wegner
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, University Magdeburg, Magdeburg, Germany
| | - Andrea Köhn
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Bretschneider
- Department of Pediatrics, Hospital Marienstift Magdeburg, Magdeburg, Germany
| | - Kristina Freese
- Department of Obstetrics and Gynecology, Hospital Marienstift Magdeburg, Magdeburg, Germany
| | - Mathias Heiduk
- Department of Pediatrics, Hospital Magdeburg gGmbH, Magdeburg, Germany
| | - Anke Redlich
- Department of Obstetrics and Gynaecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Daniela Schleef
- Department of Obstetrics and Gynecology, Hospital Magdeburg GmbH, Magdeburg, Germany
| | - Gerhard Jorch
- Department of Paediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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20
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Kikuchi D, Obara T, Usuzaki T, Yonezawa Y, Yamashita T, Oyanagi G, Noda A, Ueno F, Murakami K, Matsubara H, Ishikuro M, Metoki H, Kikuya M, Kuriyama S. Evaluating folic acid supplementation among Japanese pregnant women with dietary intake of folic acid lower than 480 µg per day: results from TMM BirThree Cohort Study. J Matern Fetal Neonatal Med 2020; 35:964-969. [PMID: 32166991 DOI: 10.1080/14767058.2020.1739020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: In Japan, supplementation with 400 µg of folic acid per day is recommended for women who are planning to get pregnant to decrease the risk of their babies getting neural tube defects (NTD). However, the proportion of women who have taken folic acid supplements before conception is low among Japanese pregnant women. In addition, the dietary intake of folic acid has not yet reached the government recommended dietary intake levels (480 µg per day). This study aimed to clarify the prevalence and determinants of adequate folic acid supplements among Japanese pregnant women with dietary folic acid intake lower than 480 µg per day.Methods: This cross-sectional study was a part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. We collected information on folic acid supplements before conception, sociological/lifestyle characteristics, and food consumption. The primary outcome was the use of folic acid supplements (adequate or inadequate, based on the timing of initiation of folic acid supplements). Multiple logistic regression analysis was used to examine the association between sociological/lifestyle characteristics and the adequate intake of folic acid supplements.Results: Among the 11,562 pregnant women who took lower than 480 µg per day of folic acid from food, the prevalence of adequate users was 18.0%. Pregnant women who reported adequate use of folic acid supplements were more likely to be older and educated; and reported higher household income, and history of fertility treatment. Conversely, they were less likely to be ever or current smokers and multipara.Conclusion: This study found that the prevalence of folic acid supplements use for the prevention of NTD among Japanese pregnant women was still low.
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Affiliation(s)
- Daisuke Kikuchi
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Takuma Usuzaki
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yudai Yonezawa
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Innovation Division, Kagome Co., Ltd, Nasushiobara, Japan
| | - Takahiro Yamashita
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Innovation Division, Kagome Co., Ltd, Nasushiobara, Japan
| | - Gen Oyanagi
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Aoi Noda
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Fumihiko Ueno
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Keiko Murakami
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hiroko Matsubara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Mami Ishikuro
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahiro Kikuya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
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21
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Reynolds CME, Egan B, O'Malley EG, Kennedy RAK, Sheehan SR, Turner MJ. A longitudinal, observational study of women who persisted in smoking in successive pregnancies. J Public Health (Oxf) 2020; 42:e18-e25. [PMID: 30608605 DOI: 10.1093/pubmed/fdy222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 04/10/2018] [Accepted: 12/06/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This longitudinal study examined the profile and pregnancy-related behaviours of women who reported smoking in two successive pregnancies when they presented for prenatal care in a large maternity hospital. METHODS Using the hospital electronic medical records, women who delivered two successive singleton pregnancies during the years 2011-15 were analyzed. Standardized data were computerized by a midwife at the first prenatal visit, following delivery and before discharge. RESULTS Over the 5 years, 6647 women delivered twice. Overall 5754 (86.6%) were persistent non-smokers in both pregnancies, 609 (9.2%) were persistent smokers in both pregnancies and between pregnancies 202 (3.0%) quit and 82 (1.2%) started smoking. Compared with persistent non-smokers, persistent smokers had higher rates of reported illicit drug use, alcohol consumption and psychological problems and lower rates of planned pregnancy, folic acid supplementation and breastfeeding in both pregnancies (all P < 0.001). In persistent smokers, folic acid supplementation practices deteriorated and illicit drug use increased in the subsequent pregnancy. CONCLUSIONS We found that approximately one in 10 women smoked in two consecutive pregnancies. Furthermore, compared with non-smokers, persistent smokers were more likely to report other health behaviours associated with adverse pregnancy outcomes and may require additional multidisciplinary support.
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Affiliation(s)
- C M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Ireland.,UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - B Egan
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.,School of Health and Human Performance, Dublin City University, Ireland
| | - E G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Ireland
| | - R A K Kennedy
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Ireland
| | - S R Sheehan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Ireland
| | - M J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Ireland
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Abstract
The results from epidemiologic studies linking blood folate concentrations, folic acid supplementation, or dietary folate to the risk of preterm birth are inconsistent. In this study, we aimed to summarize the available evidence on these associations. A systematic search of the PubMed/MEDLINE, Google Scholar, Web of Science, and Cochrane Library databases up to October 20, 2018 was performed and reference lists of retrieved articles were screened. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the highest vs. the lowest levels of folate concentrations, folic acid supplementation, and dietary folate were calculated using random-effects models. Subgroup analyses and univariate meta-regression were performed to explore the sources of heterogeneity. Ten studies (six prospective cohort studies and four case-control studies) were included on folate concentrations, 13 cohort studies were included about folic acid supplementation, and 4 cohort studies were included regarding dietary folate intake. Higher maternal folate levels were associated with a 28% reduction in the risk of preterm birth (OR 0.72, 95% CI 0.56–0.93). Higher folic acid supplementation was associated with 10% lower risk of preterm birth (OR 0.90, 95% CI 0.85–0.95). In addition, a significant negative association was observed between dietary folate intake and the risk of preterm birth (OR 0.68, 95% CI 0.55–0.84), but no significant relation was seen between dietary folate and the risk of spontaneous preterm birth (OR 0.89, 95% CI 0.57–1.41). In the subgroup analysis, higher maternal folate levels in the third trimester were associated with a lower risk of preterm birth (OR 0.58, 95% CI 0.36–0.94). To initiate taking folic acid supplementation early before conception was adversely associated with preterm birth risk (OR 0.89, 95% CI 0.83–0.95). In conclusion, higher maternal folate levels and folic acid supplementation were significantly associated with a lower risk of preterm birth. The limited data currently available suggest that dietary folate is associated with a significantly decreased risk of preterm birth.
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Affiliation(s)
- Bingbing Li
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xirui Peng
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Shan Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Perinatal Center, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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23
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Nishigori H, Obara T, Nishigori T, Ishikuro M, Sakurai K, Hoshiai T, Saito M, Fujiwara I, Arima T, Nakai K, Kuriyama S, Mano N, Metoki H, Yaegashi N, Saito H, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Kamijima M, Nakayama T, Iso H, Shima M, Hirooka Y, Suganuma N, Kusuhara K, Katoh T. Preconception folic acid supplementation use and the occurrence of neural tube defects in Japan: A nationwide birth cohort study of the Japan Environment and Children's Study. Congenit Anom (Kyoto) 2019; 59:110-117. [PMID: 29900595 DOI: 10.1111/cga.12293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022]
Abstract
We evaluated the relationship between preconception folic acid supplementation and the occurrence of neural tube defects (NTDs) in offspring, using data from the Japan Environment and Children's Study (a nationwide prospective birth cohort study) database. Of 92 269 participants with single pregnancies, 74 cases (offspring or fetuses) had NTDs, including 32 cases of spina bifida, 24 cases of anencephaly, and 19 cases of encephalocele. A total of 7634 participants (8.27%) used preconception folic acid supplementation, and of these, 621 (0.67%) also took in dietary folic acid at ≥480 μg/day. Multivariate logistic regression analyses demonstrated no association between preconception folic acid supplementation and NTDs in offspring or fetuses (odds ratio [OR] 0.622; 95% confidence interval [CI]: 0.226-1.713). Moreover, the participants who combined preconception folic acid supplement use with dietary folic acid intake ≥480 μg/day demonstrated no incidence of NTDs in offspring or fetuses. Our analysis is limited by the absence of the data on the daily amount of supplementary folic acid intake, requiring careful attention to the interpretation. Additional surveys are required in Japan to resolve those limitations for further comprehensive assessment.
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Affiliation(s)
- Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Taku Obara
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Toshie Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Kasumi Sakurai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tetsuro Hoshiai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ikuma Fujiwara
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takahiro Arima
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kunihiko Nakai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Kuriyama
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan.,International Research Institute for Disaster Science, Tohoku University, Sendai, Miyagi, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Hirohisa Saito
- National Center for Child Health and Development Tokyo Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Koichi Kusuhara
- University of Occupational and Environmental Health Kitakyushu Japan
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24
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Zhang X, Liu J, Jin Y, Yang S, Song Z, Jin L, Wang L, Ren A. Folate of pregnant women after a nationwide folic acid supplementation in China. Matern Child Nutr 2019; 15:e12828. [PMID: 30970178 DOI: 10.1111/mcn.12828] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
Folate insufficiency during the periconceptional period increases the risk of neural tube defects (NTDs) in offspring, and folic acid supplementation substantially reduces the risk. Widespread large-scale folic acid supplementation (0.4-mg folic acid tablet) has been adopted as a main strategy to prevent NTDs in China since 2009. We examined folate concentrations in plasma and red blood cells (RBCs) of pregnant women and the factors associated with blood folate concentrations in a population with a high prevalence of NTDs in northern China. A cross-sectional survey was conducted in 2014, and 1,107 pregnant women were recruited from 11 county or city maternal and child health centres across Shanxi province. Microbiological assays were used to determine folate concentrations. Factors associated with blood folate insufficiency were identified. The median (25th and 75th percentiles) folate concentrations were 28.4 (17.6, 45.2) nmol L-1 and 1,001.2 (658.7, 1,402.5) nmol L-1 in plasma and RBCs, respectively. According to the proposed RBC (906 nmol L-1 ) concentrations for optimal NTD prevention, 42.4% participants had RBC folate insufficiency. Rural women had a higher proportion of folate insufficiency than urban women. Folic acid supplementation was the only factor associated with RBC folate insufficiency. A large proportion of women had RBC folate concentrations that are not optimal for the prevention of NTDs despite free access to folic acid supplements. Actions that aim to improve folic acid supplementation compliance are needed to reach the full potential of the nationwide folic acid supplementation programme in terms of NTD prevention.
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Affiliation(s)
- Xuejuan Zhang
- Health Education Division, Shanxi Children's Hospital/Shanxi Maternal and Child Health Care Hospital, Taiyuan, P. R. China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yongsheng Jin
- Department of Maternal and Child Health, Health Commission of Shanxi Province, Taiyuan, P. R. China
| | - Shuang Yang
- Department of Child and Adolescences, School of Public Health, Shanxi Medical University, Taiyuan, P. R. China
| | - Zhijiao Song
- Health Education Division, Shanxi Children's Hospital/Shanxi Maternal and Child Health Care Hospital, Taiyuan, P. R. China
| | - Lei Jin
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Linlin Wang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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25
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Camier A, Kadawathagedara M, Lioret S, Bois C, Cheminat M, Dufourg MN, Charles MA, de Lauzon-Guillain B. Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort. Nutrients 2019; 11:nu11051108. [PMID: 31109064 PMCID: PMC6566921 DOI: 10.3390/nu11051108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l’Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.
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Affiliation(s)
- Aurore Camier
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Manik Kadawathagedara
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Sandrine Lioret
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Corinne Bois
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | - Marie Cheminat
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | | | - Marie Aline Charles
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | - Blandine de Lauzon-Guillain
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- INRA, U1125 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
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26
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Yang Y, Yang S, Liu J, Feng Y, Qi F, Zhao R. DNA Hypomethylation of GR Promoters is Associated with GR Activation and BDNF/AKT/ERK1/2-Induced Hippocampal Neurogenesis in Mice Derived From Folic-Acid-Supplemented Dams. Mol Nutr Food Res 2019; 63:e1801334. [PMID: 30920123 DOI: 10.1002/mnfr.201801334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/20/2019] [Indexed: 12/20/2022]
Abstract
SCOPE Glucocorticoid receptor (GR) mediates the nutritional programing of offspring performance. Maternal folic acid has been shown to regulate hippocampal neurogenesis and affect cognitive function in offspring, yet it remains unclear whether and how GR is involved in such effects. METHODS AND RESULTS Adult male mice derived from dams fed basal or folic-acid-supplemented diet (5 mg folic acid/kg) throughout gestation and lactation are used in this study. Maternal folic acid significantly enhances offspring learning and memory with less fear-related behavior. Concurrently, hippocampal neurogenesis is improved with upregulation of brain-derived neurotrophic factor and its downstream AKT/ERK1/2 signaling pathway. More GR immune-positive cells are observed in hippocampus of folic acid group, which are in line with higher GR protein and mRNA abundances. Differential expression of GR exon 1 transcript variants is detected, which is inversely associated with modified DNA methylation on their alternate promoters. CONCLUSION The results indicate that maternal folic acid supplementation promotes hippocampal neurogenesis and improves learning and memory behavior in mouse offspring. The mechanisms involve modification of DNA methylation on GR alternate promoters and GR upregulation in the hippocampus, which is associated with activation of BDNF/AKT/ERK1/2 signaling.
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Affiliation(s)
- Yang Yang
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
| | - Shu Yang
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
| | - Jie Liu
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
| | - Yue Feng
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
| | - Fulei Qi
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
| | - Ruqian Zhao
- MOE Joint International Research Laboratory of Animal Health & Food Safety, Nanjing Agricultural University, Nanjing, 210095, P. R. China.,Key Laboratory of Animal Physiology & Biochemistry, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, P. R. China
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27
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Aoun A, Faddoul L, El Jabbour F, El Osta N, Hlais S, El Osta L. Are the Level of Knowledge and Practices of Pregnant Women Regarding Folic Acid Supplementation Still Inadequate? A Cross-Sectional Study in a Middle Eastern Urban Setting. J Diet Suppl 2018; 15:692-703. [PMID: 29131701 DOI: 10.1080/19390211.2017.1385563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This observational cross-sectional study aimed to examine the knowledge and practices of pregnant women in North Lebanon regarding periconceptional folic acid (FA) supplementation. A convenience sample of pregnant women attending gynecology clinics in North Lebanon was recruited between May and September 2013. Data were collected from a face-to-face interview performed by a trained local dietician as well as from review of obstetric charts. A total of 465 women were included in the study. Only 37 (7.9%) were aware of the role of FA in preventing birth defects, while 129 (27.7%) were able to identify one food item rich in FA or folate. Only 125 (26.9%) were taking FA supplementation before pregnancy. While 440 (94.6%) participants were taking FA supplements during pregnancy, 158 (34%) were receiving an inadequate dose. Adequate preconceptional supplementation of FA was significantly associated with the women's level of education (p =.008), planned pregnancy (p <.0001), and gynecologic visit before pregnancy (p <.0001). Moreover, young age (p =.003) and small number of children (p =.019) were significant predictors of adequate supplementation during pregnancy. Our study revealed deficient knowledge and inadequate intake of FA supplements before and during pregnancy.
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Affiliation(s)
- Antoine Aoun
- a Notre Dame University Louaize , Department of Nursing and Health Sciences , Zouk Mosbeh , Lebanon
| | - Lara Faddoul
- b Universite Saint-Esprit de Kaslik , Département de Nutrition Humaine et Diététique , Jounieh , Lebanon
| | - Flora El Jabbour
- c Universite Libanaise , Département de Nutrition et Diététique , Beirut , Lebanon
| | - Nada El Osta
- d Universite Saint-Joseph , Faculté des Sciences Médicales , Beirut , Lebanon
| | - Sani Hlais
- d Universite Saint-Joseph , Faculté des Sciences Médicales , Beirut , Lebanon.,e American University of Beirut , Faculty of Medicine , Beirut , Lebanon
| | - Lana El Osta
- d Universite Saint-Joseph , Faculté des Sciences Médicales , Beirut , Lebanon
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28
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Smelt HJM, Pouwels S, Said M, Smulders JF. Neuropathy by folic acid supplementation in a patient with anaemia and an untreated cobalamin deficiency: a case report. Clin Obes 2018; 8:300-304. [PMID: 29852529 DOI: 10.1111/cob.12254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 11/27/2022]
Abstract
The rising rates of bariatric surgery (BS) are accompanied by neurological complications related to nutrient deficiencies. One of the risk factors for neurological complications in BS patients is poor vitamin and mineral supplementation. Prevention, diagnosis and treatment of these disorders are necessary parts of lifelong care after BS. Particularly important for optimal functioning of the nervous system are vitamin B1 , B6 , B12 (cobalamin), E, copper and possibly vitamin B11 (folic acid). In this case report, we narrate about a patient with anaemia and multiple vitamin and mineral deficiencies after Roux-en-Y gastric bypass (RYGB) with an alimentary limb of 150 cm and a biliopancreatic limb of 100 cm. RYGB is associated with an increased risk of vitamin deficiencies, especially a vitamin B12 deficiency. The patient in this case report developed psychiatric-neurological symptoms due to folic acid supplementation in an untreated cobalamin deficiency. Second, we tried to elucidate the vitamin physiology to understand specific mechanisms after BS.
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Affiliation(s)
- H J M Smelt
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - S Pouwels
- Department of Surgery, Sint Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | - M Said
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - J F Smulders
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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29
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Zhu X, Wei L, Cao D, Liu C, Tian J, Long Y, Huang S, Ou L, Yang X, Mo Z. Low serum folate status in the second trimester increase the risk of low birthweight in Chinese women. J Obstet Gynaecol Res 2018; 44:2037-2044. [PMID: 30019799 DOI: 10.1111/jog.13757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/23/2018] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to explore the influence of maternal folate and vitamin B12 (B12) status during pregnancy on the incidence of low birthweight (LBW) infants. METHODS A total of 6203 eligible women registered in seven hospitals in southern China, and 230 cases with singleton live births and 382 controls were matched for further analyses. The concentrations of serum folate and B12 were detected with chemiluminescence microparticle immunoassay on ARCHITECT i2000-1. Conditional logistic regression was used to evaluate the effects of folate and B12 levels on LBW. RESULTS Maternal serum folate levels increased basically with increasing the period of folic acid supplementation (P trend <0.001). Moreover, maternal serum folate and B12 levels gradually decreased with the increase of gestational age (P < 0.001). Conditional logistic regressions analysis results showed increased odds ratios (OR) for LBW from the fourth to first folate quartiles (P trend <0.01) in the second trimester. Compared with the women in the highest quartile, those in the lowest quartile of serum folate in the second trimester were found with higher risk of LBW (adjusted OR = 1.67, 95% confidence interval [CI]: 1.02-2.73). However, no significant association was observed between serum folate and LBW in the first trimester or third trimester. In addition, serum B12 exhibited no significant association with LBW. CONCLUSIONS Low serum folate levels in the second trimester significantly increases the risk of LBW amongst Chinese women with singleton pregnancies.
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Affiliation(s)
- Xiujuan Zhu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,School of Public Health, Guangxi Medical University, Nanning, China
| | - Luyun Wei
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,School of Public Health, Guangxi Medical University, Nanning, China
| | - Dehao Cao
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,School of Public Health, Guangxi Medical University, Nanning, China
| | - Chaoqun Liu
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Jiarong Tian
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Yu Long
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shengzhu Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,School of Public Health, Guangxi Medical University, Nanning, China
| | - Liqian Ou
- Department of Clinical Laboratory, Maternal & Child Health Hospital of Yuzhou, Yulin, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,School of Public Health, Guangxi Medical University, Nanning, China.,Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, China
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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30
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Stokes BA, Sabatino JA, Zohn IE. High levels of iron supplementation prevents neural tube defects in the Fpn1 ffe mouse model. Birth Defects Res 2018; 109:81-91. [PMID: 28008752 DOI: 10.1002/bdra.23542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/11/2016] [Accepted: 06/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Periconception maternal nutrition and folate in particular are important factors influencing the incidence of neural tube defects (NTDs). Many but not all NTDs are prevented by folic acid supplementation and there is a pressing need for additional strategies to prevent these birth defects. Other micronutrients such as iron are potential candidates, yet a clear role for iron deficiency in contributing to NTDs is lacking. Our previous studies with the flatiron (ffe) mouse model of Ferroportin1 (Fpn1) deficiency suggest that iron is required for neural tube closure and forebrain development raising the possibility that iron supplementation could prevent NTDs. METHODS We determined the effect of periconception iron and/or folic acid supplementation on the penetrance of NTDs in the Fpn1ffe mouse model. Concurrently, measurements of folate and iron were made to ensure supplementation had the intended effects. RESULTS High levels of iron supplementation significantly reduced the incidence of NTDs in Fpn1ffe mutants. Fpn1 deficiency resulted in reduced folate levels in both pregnant dams and embryos. Yet folic acid supplementation did not prevent NTDs in the Fpn1ffe model. Similarly, forebrain truncations were rescued with iron. Surprisingly, the high levels of iron supplementation used in this study caused folate deficiency in wild-type dams and embryos. CONCLUSION Our results demonstrate that iron supplementation can prevent NTDs and forebrain truncations in the Fpn1ffe model. Surprisingly, high levels of iron supplementation and iron overload can cause folate deficiency. If iron is essential for neural tube closure, it is possible that iron deficiency might contribute to NTDs. Birth Defects Research 109:81-91, 2017. © 2016 The Authors Birth Defects Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Bethany A Stokes
- Department of Biology, The George Washington University, Washington, DC.,Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Julia A Sabatino
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Irene E Zohn
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC
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31
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Sabatino JA, Stokes BA, Zohn IE. Prevention of neural tube defects in Lrp2 mutant mouse embryos by folic acid supplementation. Birth Defects Res 2018; 109:16-26. [PMID: 27883261 DOI: 10.1002/bdra.23589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/18/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neural tube defects (NTDs) are among the most common structural birth defects in humans and are caused by the complex interaction of genetic and environmental factors. Periconceptional supplementation with folic acid can prevent NTDs in both mouse models and human populations. A better understanding of how genes and environmental factors interact is critical toward development of rational strategies to prevent NTDs. Low density lipoprotein-related protein 2 (Lrp2) is involved in endocytosis of the folic acid receptor among numerous other nutrients and ligands. METHODS We determined the effect of iron and/or folic acid supplementation on the penetrance of NTDs in the Lrp2null mouse model. The effects of supplementation on folate and iron status were measured in embryos and dams. RESULTS Periconceptional dietary supplementation with folic acid did not prevent NTDs in Lrp2 mutant embryos, whereas high levels of folic acid supplementation by intraperitoneal injection reduced incidence of NTDs. Importantly, Lrp2null/+ dams had reduced blood folate levels that improved with daily intraperitoneal injections of folate but not dietary supplementation. On the contrary, iron supplementation had no effect on the penetrance of NTDs in Lrp2 mutant embryos and negated the preventative effect of folic acid supplementation in Lrp2null/null mutants. CONCLUSION Lrp2 is required for folate homeostasis in heterozygous dams and high levels of supplementation prevents NTDs. Furthermore, high levels of dietary iron supplementation interfered with folic acid supplementation negating the positive effects of supplementation in this model. Birth Defects Research 109:16-26, 2017. © 2016 The Authors Birth Defects Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Julia A Sabatino
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Bethany A Stokes
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC.,Department of Biology, The George Washington University, Washington, DC
| | - Irene E Zohn
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC
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Paniz C, Bertinato JF, Lucena MR, De Carli E, Amorim PMDS, Gomes GW, Palchetti CZ, Figueiredo MS, Pfeiffer CM, Fazili Z, Green R, Guerra-Shinohara EM. A Daily Dose of 5 mg Folic Acid for 90 Days Is Associated with Increased Serum Unmetabolized Folic Acid and Reduced Natural Killer Cell Cytotoxicity in Healthy Brazilian Adults. J Nutr 2017; 147:1677-1685. [PMID: 28724658 PMCID: PMC5712455 DOI: 10.3945/jn.117.247445] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/25/2017] [Accepted: 06/15/2017] [Indexed: 01/01/2023] Open
Abstract
Background: The effects of high-dose folic acid (FA) supplementation in healthy individuals on blood folate concentrations and immune response are unknown.Objective: The aim of the study was to evaluate the effects of daily consumption of a tablet containing 5 mg FA on serum folate; number and cytotoxicity of natural killer (NK) cells; mRNA expression of dihydrofolate reductase (DHFR), methylenetetrahydrofolate reductase (MTHFR), interferon γ (IFNG), tumor necrosis factor α (TNFA), and interleukin 8 (IL8) genes; and concentrations of serum inflammatory markers.Methods: This prospective clinical trial was conducted in 30 healthy Brazilian adults (15 women), aged 27.7 y (95% CI: 26.4, 29.1 y), with a body mass index (in kg/m2) of 23.1 (95% CI: 22.0, 24.3). Blood was collected at baseline and after 45 and 90 d of the intervention. Serum folate concentrations were measured by microbiological assay and HPLC-tandem mass spectrometry [folate forms, including unmetabolized folic acid (UMFA)]. We used real-time polymerase chain reaction to assess mononuclear leukocyte mRNA expression and flow cytometry to measure the number and cytotoxicity of NK cells.Results: Serum folate concentrations increased by ∼5-fold after the intervention (P < 0.001), and UMFA concentrations increased by 11.9- and 5.9-fold at 45 and 90 d, respectively, when compared with baseline (P < 0.001). UMFA concentrations increased (>1.12 nmol/L) in 29 (96.6%) participants at day 45 and in 26 (86.7%) participants at day 90. We observed significant reductions in the number (P < 0.001) and cytotoxicity (P = 0.003) of NK cells after 45 and 90 d. Compared with baseline, DHFR mRNA expression was higher at 90 d (P = 0.006) and IL8 and TNFA mRNA expressions were higher at 45 and 90 d (P = 0.001 for both).Conclusion: This noncontrolled intervention showed that healthy adults responded to a high-dose FA supplement with increased UMFA concentrations, changes in cytokine mRNA expression, and reduced number and cytotoxicity of NK cells. This trial was registered at www.ensaiosclinicos.gov.br as RBR-2pr7zp.
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Affiliation(s)
- Clovis Paniz
- Departments of Clinical and Toxicological Analysis and
| | | | - Maylla Rodrigues Lucena
- Hematology and Blood Transfusion Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo De Carli
- Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Maria Stella Figueiredo
- Hematology and Blood Transfusion Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Zia Fazili
- National Center for Environmental Health, CDC, Atlanta, GA; and
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA
| | - Elvira Maria Guerra-Shinohara
- Departments of Clinical and Toxicological Analysis and
- Hematology and Blood Transfusion Division, Federal University of Sao Paulo, Sao Paulo, Brazil
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Yang X, Huang Y, Sun C, Li J. Maternal Prenatal Folic Acid Supplementation Programs Offspring Lipid Metabolism by Aberrant DNA Methylation in Hepatic ATGL and Adipose LPL in Rats. Nutrients 2017; 9:E935. [PMID: 28846595 DOI: 10.3390/nu9090935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022] Open
Abstract
The effects of maternal prenatal folic acid supplementation (FAS) on offspring lipid metabolism in adulthood remains unclear, although prenatal FAS is compulsively suggested in many countries. Female Sprague-Dawley rats were fed with control (CON) or FAS diets before and during pregnancy. Male offspring of CON and FAS dams were further divided into two groups at seven weeks for CON and high-fat (HF) diet interventions for eight weeks in adulthood (n = 10). The interactive effects of maternal prenatal FAS and offspring HF in adulthood on lipid metabolism and DNA methylation of genes involved in lipids metabolism were assessed. The male offspring of FAS dams had elevated serum and liver triglyceride level when fed with HF compared to the male offspring of CON dams. The mRNA and protein expression levels of hepatic ATGL and adipose LPL were significantly decreased in offspring of FAS dams than in offspring of CON dams. Furthermore, maternal prenatal FAS resulted in elevated DNA methylation levels in the promoter and first exon region of hepatic ATGL and adipose LPL in offspring. Maternal FAS exacerbated the adverse effects of HF on lipid metabolism in offspring through inducing aberrant DNA methylation levels of hepatic ATGL and adipose LPL.
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Neogi SB, Singh S, Pallepogula DR, Pant H, Kolli SR, Bharti P, Datta V, Gosla SR, Bonanthaya K, Ness A, Kinra S, Doyle P, Gudlavalleti VSM. Risk factors for orofacial clefts in India: A case-control study. Birth Defects Res 2017; 109:1284-1291. [PMID: 28766884 PMCID: PMC6686724 DOI: 10.1002/bdr2.1073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 01/09/2023]
Abstract
Background Orofacial clefts (OFC) are linked with several genetic and environmental factors. The aim of this study was to explore the association of potential risk factors with OFCs in India. Methods This was a hospital‐based, matched case–control (1:4 ratio; matching done for parity) study conducted in Hyderabad, Bengaluru, and Delhi‐National Capital Region. Cases (nonsyndromic clefts) were recruited from treatment centers, while controls (live births) were recruited from maternity centers. Information on exposures was collected during personal interviews. Exposures of interest included folic acid supplementation during the peri‐conceptional period, consanguineous marriage, exposure to drugs, infections during pregnancy, family history of OFC, and dietary factors. Results A total of 785 participants were included in the study: 157 cases and 628 controls. A family history of cleft lip/palate (adjusted odds ratio [AOR], 15.48; 95% confidence interval [CI], 4.36–54.96; p value = 0.001), exclusive vegetarianism (AOR, 4.47; 95% CI, 1.83–10.98; p value = 0.001), and delayed first conception (AOR, 2.55, 95% CI, 1.25–5.21, p = 0.01) were found to be strongly associated with higher risk of OFCs. Supplementation with folic acid during first 3 months of pregnancy was not found to be protective against OFCs (AOR, 1.24; 95% CI, 0.59–2.58; p value = 0.56). Conclusion Our study confirmed the importance of family history as a risk factor for OFC. Our study did not show an association with folic acid supplementation but was underpowered to detect small effects. Our finding of higher risk among vegetarians requires replication. Birth Defects Research 109:1284–1291, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Samiksha Singh
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Dinesh Raj Pallepogula
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Hira Pant
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Sunanda Reddy Kolli
- Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability related Health Initiatives (CARENIDHI), New Delhi, India
| | - Priyanka Bharti
- Indian Institute of Public Health- Delhi, Public Health Foundation of India, New Delhi, India
| | - Vikram Datta
- Kalawati Saran Hospital and Lady Hardinge Medical College, New Delhi, India
| | | | | | - Andy Ness
- The UK National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, United Kingdom
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pat Doyle
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Qin X, Li Y, He M, Tang G, Yin D, Liang M, Wang B, Nie J, Huo Y, Xu X, Hou FF. Folic acid therapy reduces serum uric acid in hypertensive patients: a substudy of the China Stroke Primary Prevention Trial (CSPPT). Am J Clin Nutr 2017; 105:882-889. [PMID: 28148501 DOI: 10.3945/ajcn.116.143131] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The effect of folic acid supplementation on uric acid (UA) concentrations is still inconclusive.Objective: We aimed to test the efficacy of folic acid therapy in reducing serum UA in hypertensive patients.Design: A total of 15,364 hypertensive patients were randomly assigned to a double-blind daily treatment with a single tablet that contained 10 mg enalapril and 0.8 mg folic acid (n = 7685) or 10 mg enalapril alone (n = 7679). The main outcome was the change in serum UA, which was defined as UA at the exit visit minus that at baseline. Secondary outcomes were as follows: 1) controlled hyperuricemia (UA concentration <357 μmol/L after treatment) and 2) new-onset hyperuricemia in participants with normal UA concentrations (<357 μmol/L).Results: After a median of 4.4 y of treatment, the mean ± SD UA concentration increased by 34.7 ± 72.5 μmol/L in the enalapril-alone group and by 30.7 ± 71.8 μmol/L in the enalapril-folic acid group, which resulted in a mean group difference of -4.0 μmol/L (95% CI: -6.5, -1.6 μmol/L; P = 0.001). Furthermore, compared with enalapril alone, enalapril-folic acid treatment showed an increase in controlled hyperuricemia (30.3% compared with 25.6%; OR: 1.31; 95% CI: 1.01, 1.70) and a decrease in new-onset hyperuricemia (15.0% compared with 16.3%; OR: 0.89; 95% CI: 0.79, 0.99). A greater beneficial effect was observed in subjects with hyperuricemia (P-interaction = 0.07) or higher concentrations of total homocysteine (tHcy) (P-interaction = 0.02) at baseline. Furthermore, there was a significant inverse relation (P < 0.001) between the reduction of tHcy and the change in UA concentrations.Conclusions: Enalapril-folic acid therapy, compared with enalapril alone, can significantly reduce the magnitude of the increase of UA concentrations in hypertensive adults. This trial was registered at clinicaltrials.gov as NCT00794885.
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Affiliation(s)
- Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Genfu Tang
- Institute for Biomedicine and.,School of Health Administration, Anhui Medical University, Hefei, China; and
| | - Delu Yin
- Cardiology, First People's Hospital, Lianyungang, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Binyan Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China;
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Pauwels S, Ghosh M, Duca RC, Bekaert B, Freson K, Huybrechts I, A. S. Langie S, Koppen G, Devlieger R, Godderis L. Dietary and supplemental maternal methyl-group donor intake and cord blood DNA methylation. Epigenetics 2017; 12:1-10. [PMID: 27830979 PMCID: PMC5270634 DOI: 10.1080/15592294.2016.1257450] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
Abstract
Maternal nutrition is critically involved in the development and health of the fetus. We evaluated maternal methyl-group donor intake through diet (methionine, betaine, choline, folate) and supplementation (folic acid) before and during pregnancy in relation to global DNA methylation and hydroxymethylation and gene specific (IGF2 DMR, DNMT1, LEP, RXRA) cord blood methylation. A total of 115 mother-infant pairs were enrolled in the MAternal Nutrition and Offspring's Epigenome (MANOE) study. The intake of methyl-group donors was assessed using a food-frequency questionnaire. LC-MS/MS and pyrosequencing were used to measure global and gene specific methylation, respectively. Dietary intake of methyl-groups before and during pregnancy was associated with changes in LEP, DNMT1, and RXRA cord blood methylation. Statistically significant higher cord blood LEP methylation was observed when mothers started folic acid supplementation more than 6 months before conception compared with 3-6 months before conception (34.6 ± 6.3% vs. 30.1 ± 3.6%, P = 0.011, LEP CpG1) or no folic acid used before conception (16.2 ± 4.4% vs. 13.9 ± 3%, P = 0.036 for LEP CpG3 and 24.5 ± 3.5% vs. 22.2 ± 3.5%, P = 0.045 for LEP mean CpG). Taking folic acid supplements during the entire pregnancy resulted in statistically significantly higher cord blood RXRA methylation as compared with stopping supplementation in the second trimester (12.3 ± 1.9% vs. 11.1 ± 2%, P = 0.008 for RXRA mean CpG). To conclude, long-term folic acid use before and during pregnancy was associated with higher LEP and RXRA cord blood methylation, respectively. To date, pregnant women are advised to take a folic acid supplement of 400 µg/day from 4 weeks before until 12 weeks of pregnancy. Our results suggest significant epigenetic modifications when taking a folic acid supplement beyond the current advice.
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Affiliation(s)
- Sara Pauwels
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, Environment and Health, Leuven, Belgium
- Flemish Institute of Technological Research (VITO), Unit Environmental Risk and Health, Mol, Belgium
| | - Manosij Ghosh
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, Environment and Health, Leuven, Belgium
| | - Radu Corneliu Duca
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, Environment and Health, Leuven, Belgium
| | - Bram Bekaert
- KU Leuven - University of Leuven, Department of Imaging & Pathology, Leuven, Belgium
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Forensic Medicine, Laboratory of Forensic Genetics and Molecular Archeology, Leuven, Belgium
| | - Kathleen Freson
- KU Leuven - University of Leuven, Center for Molecular and Vascular Biology, Leuven, Belgium
| | - Inge Huybrechts
- International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France
| | - Sabine A. S. Langie
- Flemish Institute of Technological Research (VITO), Unit Environmental Risk and Health, Mol, Belgium
- Hasselt University, Faculty of Sciences, Diepenbeek, Belgium
| | - Gudrun Koppen
- Flemish Institute of Technological Research (VITO), Unit Environmental Risk and Health, Mol, Belgium
| | - Roland Devlieger
- KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
- University Hospitals of Leuven, Department of Obstetrics and Gynecology, Leuven, Belgium
| | - Lode Godderis
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, Environment and Health, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
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Chan D, McGraw S, Klein K, Wallock LM, Konermann C, Plass C, Chan P, Robaire B, Jacob RA, Greenwood CMT, Trasler JM. Stability of the human sperm DNA methylome to folic acid fortification and short-term supplementation. Hum Reprod 2016; 32:272-283. [PMID: 27994001 DOI: 10.1093/humrep/dew308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/26/2016] [Accepted: 11/07/2016] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Do short-term and long-term exposures to low-dose folic acid supplementation alter DNA methylation in sperm? SUMMARY ANSWER No alterations in sperm DNA methylation patterns were found following the administration of low-dose folic acid supplements of 400 μg/day for 90 days (short-term exposure) or when pre-fortification of food with folic acid and post-fortification sperm samples (long-term exposure) were compared. WHAT IS KNOWN ALREADY Excess dietary folate may be detrimental to health and DNA methylation profiles due to folate's role in one-carbon metabolism and the formation of S-adenosyl methionine, the universal methyl donor. DNA methylation patterns are established in developing male germ cells and have been suggested to be affected by high-dose (5 mg/day) folic acid supplementation. STUDY DESIGN, SIZE, DURATION This is a control versus treatment study where genome-wide sperm DNA methylation patterns were examined prior to fortification of food (1996-1997) in men with no history of infertility at baseline and following 90-day exposure to placebo (n = 9) or supplement containing 400 μg folic acid/day (n = 10). Additionally, pre-fortification sperm DNA methylation profiles (n = 19) were compared with those of a group of post-fortification (post-2004) men (n = 8) who had been exposed for several years to dietary folic acid fortification. PARTICIPANTS/MATERIALS, SETTING, METHODS Blood and seminal plasma folate levels were measured in participants before and following the 90-day treatment with placebo or supplement. Sperm DNA methylation was assessed using the whole-genome and genome-wide techniques, MassArray epityper, restriction landmark genomic scanning, methyl-CpG immunoprecipitation and Illumina HumanMethylation450 Bead Array. MAIN RESULTS AND THE ROLE OF CHANCE Following treatment, supplemented individuals had significantly higher levels of blood and seminal plasma folates compared to placebo. Initial first-generation genome-wide analyses of sperm DNA methylation showed little evidence of changes when comparing pre- and post-treatment samples. With Illumina HumanMethylation450 BeadChip arrays, no significant changes were observed in individual probes following low-level supplementation; when compared with those of the post-fortification cohort, there were also few differences in methylation despite exposure to years of fortified foods. LARGE SCALE DATA Illumina HumanMethylation450 BeadChip data from this study have been submitted to the NCBI Gene Expression Omnibus under the accession number GSE89781. LIMITATIONS, REASONS FOR CAUTION This study was limited to the number of participants available in each cohort, in particular those who were not exposed to early (pre-1998) fortification of food with folic acid. While genome-wide DNA methylation was assessed with several techniques that targeted genic and CpG-rich regions, intergenic regions were less well interrogated. WIDER IMPLICATIONS OF THE FINDINGS Overall, our findings provide evidence that short-term exposure to low-dose folic acid supplements of 400 μg/day, over a period of 3 months, a duration of time that might occur during infertility treatments, has no major impact on the sperm DNA methylome. STUDY FUNDING/COMPETING INTERESTS This work was supported by a grant to J.M.T. from the Canadian Institutes of Health Research (CIHR: MOP-89944). The authors have no conflicts of interest to declare.
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Affiliation(s)
- D Chan
- Departments of Pediatrics and of Human Genetics of McGill University, Montreal Children's Hospital and Research Institute of the McGill University Health Centre, Glen Site, 1001 Décarie Boulevard Block E- Room EM0.2236 Montreal, QC H4A 3J1, Canada
| | - S McGraw
- Department of Obstetrics and Gynaecology, Biochemistry and Molecular Medicine of Université de Montréal, Research Center of the Sainte-Justine University Hospital, Montreal, QC H3T 1C5, Canada
| | - K Klein
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - L M Wallock
- Department of Biological Sciences, Diablo Valley College, Pleasant Hill, CA 94523, USA
| | - C Konermann
- Department of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - C Plass
- Department of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - P Chan
- Royal Victoria Hospital of the McGill University Health Centre and Department of Surgery, McGill University, Montréal, QC H4A 3J1, Canada
| | - B Robaire
- Department of Pharmacology and Therapeutics, McGill University, Montréal, QC H3A 0G4, Canada
| | - R A Jacob
- USDA, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA 95616, USA
| | - C M T Greenwood
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada.,Departments of Oncology, Epidemiology, Biostatistics and Occupational Health, and Human Genetics, McGill University, Montréal, QC H4A 3J1, Canada
| | - J M Trasler
- Departments of Pediatrics and of Human Genetics of McGill University, Montreal Children's Hospital and Research Institute of the McGill University Health Centre, Glen Site, 1001 Décarie Boulevard Block E- Room EM0.2236 Montreal, QC H4A 3J1, Canada .,Department of Pharmacology and Therapeutics, McGill University, Montréal, QC H3A 0G4, Canada
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Pentieva K, Selhub J, Paul L, Molloy AM, McNulty B, Ward M, Marshall B, Dornan J, Reilly R, Parle-McDermott A, Bradbury I, Ozaki M, Scott JM, McNulty H. Evidence from a Randomized Trial That Exposure to Supplemental Folic Acid at Recommended Levels during Pregnancy Does Not Lead to Increased Unmetabolized Folic Acid Concentrations in Maternal or Cord Blood. J Nutr 2016; 146:494-500. [PMID: 26817717 DOI: 10.3945/jn.115.223644] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/21/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exposure to higher intakes of folic acid (FA) from fortified foods and supplements, although largely considered beneficial, is associated with unmetabolized FA in the circulation, which has raised some health concerns. OBJECTIVE The effect of supplemental FA at a dose of 400 μg/d during pregnancy on unmetabolized FA concentrations in maternal plasma and newborn cord blood plasma was investigated. METHODS A new analysis was performed of blood samples from participants in a randomized trial in pregnancy. Women aged 18-35 y, who had taken 400 μg FA/d as recommended in the first trimester, were recruited at the start of trimester 2 and randomly allocated to receive either 400 μg FA/d (n = 59) or a placebo (n = 67) throughout the second and third trimesters until delivery. Unmetabolized FA concentrations in maternal and cord blood samples were measured by LC-tandem MS analysis. RESULTS In response to the intervention from gestational week 14 through delivery, a higher proportion of women in the FA compared with the placebo group had detectable FA (≥0.27 nmol/L) in plasma, but the difference in concentrations was not statistically significant (mean ± SD: 0.44 ± 0.80 compared with 0.13 ± 0.49 nmol/L, P = 0.38). FA treatment throughout pregnancy resulted in higher cord blood plasma total folate (50.6 ± 20.1 compared with 34.5 ± 14.4 nmol/L; P = 0.004) and 5-methyltetrahydrofolate (50.4 ± 20.3 compared with 34.5 ± 14.4 nmol/L; P = 0.005) concentrations, but FA was detected only in 8 of 53 available cord blood samples, and the proportion of samples with detectable FA concentrations was similar in FA-treated and placebo groups. CONCLUSIONS Plasma concentrations of unmetabolized FA arising from supplemental FA at a dose of 400 μg/d, in addition to FA from fortified foods, were low or undetectable in mothers and newborns. The benefits for mothers and offspring of continuing FA supplementation beyond the first trimester of pregnancy can be achieved without posing any risk of increasing unmetabolized circulating FA, even in those already exposed to FA from fortified foods.
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Affiliation(s)
- Kristina Pentieva
- Northern Ireland Centre for Food & Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland;
| | - Jacob Selhub
- Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Ligi Paul
- Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | | | - Breige McNulty
- School of Agriculture & Food Science, University College Dublin, Dublin, Ireland
| | - Mary Ward
- Northern Ireland Centre for Food & Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland
| | - Barry Marshall
- Causeway Hospital, The Northern Health and Social Care Trust, Coleraine, Northern Ireland
| | - James Dornan
- Royal-Jubilee Maternity Service, Belfast, Northern Ireland
| | - Rosie Reilly
- Northern Ireland Centre for Food & Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland
| | | | | | - Mari Ozaki
- School of Biotechnology, Dublin City University, Dublin, Ireland; and
| | - John M Scott
- School of Biochemistry and Immunology, Trinity College, Dublin, Ireland
| | - Helene McNulty
- Northern Ireland Centre for Food & Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland
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Qin X, Li J, Zhang Y, Chen D, Wang B, He M, Fu J, Tang G, Cai Y, Shi X, Xu X, Hou FF, Wang X, Huo Y. Effect of folic acid supplementation on risk of new-onset diabetes in adults with hypertension in China: Findings from the China Stroke Primary Prevention Trial (CSPPT). J Diabetes 2016; 8:286-94. [PMID: 26455512 DOI: 10.1111/1753-0407.12346] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/14/2015] [Accepted: 10/03/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the present post hoc analysis of the China Stroke Primary Prevention Trial (CSPPT) was to evaluate the effect of folic acid supplementation on the risk of new-onset diabetes in hypertensive adults in China. METHODS In all, 20 702 hypertensive adults with no history of stroke and/or myocardial infarction (MI) were randomly assigned to receive double-blind daily treatment with tablets containing either: (i) 10 mg enalapril and 0.8 mg folic acid (n = 10 348); or (ii) 10 mg enalapril alone (n = 10 354). New-onset diabetes was defined as either self-reported physician-diagnosed diabetes or the use of glucose-lowering drugs during the follow-up period of the CSPPT. RESULTS Over a median treatment duration of 4.5 years, new-onset diabetes occurred in 198 (2.0%) and 214 (2.1%) subjects in the enalapril-folic acid and enalapril groups, respectively (hazard ratio [HR] 0.92; 95% confidence interval [CI] 0.76-1.12). Similar results were observed when analyses were limited to subjects with baseline fasting glucose (FG) <7.0 mmol/L (HR 0.85; 95% CI 0.62-1.14). Furthermore, there was no significant group difference in: (i) the risk of new-onset FG ≥7.0 mmol/L (defined as FG <7.0 at baseline and ≥7.0 mmol/L at the last visit; relative risk [RR] 1.07; 95% CI 0.96-1.20); or (ii) the composite of new-onset diabetes or new-onset FG ≥7.0 mmol/L (RR = 1.06; 95% CI 0.95-1.19). CONCLUSIONS Among adults with hypertension with no history of stroke and/or MI in China, folic acid supplementation had no significant effect on the risk of new-onset diabetes.
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Affiliation(s)
- Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing
| | - Binyan Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University
| | - Mingli He
- Department of Neurology, First People's Hospital, Lianyungang
| | - Jia Fu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University
| | - Genfu Tang
- Institute for Biomedicine
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Yefeng Cai
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Xiuli Shi
- Department of Neurology, First Affiliated Hospital of Anhui Medical University
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital
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Plumptre L, Masih SP, Ly A, Aufreiter S, Sohn KJ, Croxford R, Lausman AY, Berger H, O'Connor DL, Kim YI. High concentrations of folate and unmetabolized folic acid in a cohort of pregnant Canadian women and umbilical cord blood. Am J Clin Nutr 2015; 102:848-57. [PMID: 26269367 DOI: 10.3945/ajcn.115.110783] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mandatory fortification, prevalent supplement use, and public health guidelines recommending periconceptional supplementation have increased folic acid intakes in North American pregnant women. However, the effects of increased folic acid intakes during pregnancy on maternal and cord blood folate concentrations have not been well established. OBJECTIVES In this prospective study, we determined maternal and cord blood concentrations of folate and unmetabolized folic acid (UMFA) in a cohort of pregnant Canadian women and their newborns and examined the effect of maternal intakes of folate and folic acid and fetal genetic variants in folate metabolism on folate status. DESIGN Folate and folic acid intakes of 368 Canadian pregnant women were assessed in early (0-16 wk) and late (23-37 wk) pregnancy. Blood concentrations of folate and UMFA were measured with the use of immunoassays and liquid chromatography-mass spectrometry, respectively, in maternal samples in early pregnancy (12-16 wk), at delivery (28-42 wk), and in cord blood. Four fetal genetic variants of the 5,10-methylenetetrahydrofolate reductase (MTHFR) and dihydrofolate reductase (DHFR) genes were assessed for their association with cord blood concentrations of folate and UMFA. RESULTS Geometric mean (95% CI) maternal red blood cell (RBC) folate concentrations were 2417 nmol/L (2362, 2472 nmol/L ) and 2793 nmol/L (2721, 2867 nmol/L ) in early pregnancy and at delivery, respectively. The mean (95% CI) cord RBC folate concentration was 2689 nmol/L (2614, 2765 nmol/L). UMFA was detectable in >90% of maternal and cord plasma samples. Although 3 fetal MTHFR and DHFR genetic variants had no effect, the fetal MTHFR 677TT genotype was associated with significantly lower cord serum (P = 0.03) and higher cord RBC (P = 0.02) folate concentrations than those of the wild type. CONCLUSIONS Notwithstanding differences in assays, maternal and cord RBC folate and plasma UMFA concentrations were higher than previously reported values. Functional ramifications of high folate and UMFA concentrations in maternal and fetal circulation warrant additional investigation because an excess folate status may affect long-term health outcomes of the offspring. This study was registered at www.clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Lesley Plumptre
- Departments of Nutritional Sciences and Keenan Research Center for Biomedical Science and
| | - Shannon P Masih
- Departments of Nutritional Sciences and Keenan Research Center for Biomedical Science and
| | - Anna Ly
- Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susanne Aufreiter
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyoung-Jin Sohn
- Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science and
| | - Ruth Croxford
- Freelance statistics consultant, Toronto, Ontario, Canada; and
| | - Andrea Y Lausman
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Deborah L O'Connor
- Departments of Nutritional Sciences and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Young-In Kim
- Departments of Nutritional Sciences and Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science and Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Canada;
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Leirgul E, Gildestad T, Nilsen RM, Fomina T, Brodwall K, Greve G, Vollset SE, Holmstrøm H, Tell GS, Øyen N. Periconceptional Folic Acid Supplementation and Infant Risk of Congenital Heart Defects in Norway 1999-2009. Paediatr Perinat Epidemiol 2015. [PMID: 26212116 DOI: 10.1111/ppe.12212] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The birth prevalence of congenital heart defects (CHDs) has decreased in Canada and Europe. Recommended intake of folic acid in pregnancy is a suggestive risk-reducing factor for CHDs. We investigated the association between periconceptional intake of folic acid supplements and infant risk of CHDs. METHODS Information on maternal intake of folic acid supplements before and during pregnancy in the Medical Birth Registry of Norway 1999-2009 was updated with information on CHD diagnoses from national health registers and the Cardiovascular Diseases in Norway Project. The association between folic acid intake and infant risk of CHD was estimated as relative risk (RR) with binomial log linear regression. RESULTS Among 517 784 non-chromosomal singleton births, 6200 children were identified with CHD and 1153 with severe CHD. For all births, 18.4% of the mothers initiated folic acid supplements before pregnancy and 31.6% during pregnancy. The adjusted RR for severe CHD was 0.99 [95% confidence interval [CI] 0.86, 1.13] comparing periconceptional intake of folic acid with no intake. Specifically, RR for conotruncal defects was 0.99 [95% CI 0.80, 1.22], atrioventricular septal defects 1.19 [95% CI 0.78, 1.81], left ventricular outflow tract obstructions 1.02 [95% CI 0.78, 1.32], and right ventricular outflow tract obstructions 0.97 [95% CI 0.72, 1.29]. Birth prevalence of septal defects was higher in the group exposed to folic acid supplements with RR 1.19 [95% CI 1.10, 1.30]. CONCLUSIONS Periconceptional folic acid supplement use showed no association with severe CHDs in the newborn. An unexpected association with an increased risk of septal defects warrants further investigation.
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Affiliation(s)
- Elisabeth Leirgul
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trude Gildestad
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristoffer Brodwall
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Bergen, Norway
| | - Henrik Holmstrøm
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Bergen, Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
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Shere M, Bapat P, Nickel C, Kapur B, Koren G. Association Between Use of Oral Contraceptives and Folate Status: A Systematic Review and Meta-Analysis. J Obstet Gynaecol Can 2015; 37:430-438. [PMID: 26168104 DOI: 10.1016/s1701-2163(15)30258-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the effect of oral contraceptive use on plasma and red blood cell (RBC) folate concentrations. METHODS We searched Medline, EMBASE, Web of Science, and the Cochrane library for human studies published from inception to June 2013 evaluating oral contraceptive use and folate status. Case-control studies, cohort studies, and clinical trials were included. A random-effects model of outcomes was used for the meta-analysis. RESULTS A total of 2831 women in 17 studies were included in the analysis. In those whose plasma folate concentrations were available, there was a significant folate-lowering effect of oral contraceptives observed (mean reduction 1.27 µg/L; 95% CI 1.85 to 0.69, P < 0.001). Similarly, after analyzing data from 1389 women in 12 studies whose RBC folate concentrations were available, significantly lower folate status was observed among oral contraceptive users (mean reduction 59.32 µg/L; 95% CI 58.03 to 23.04, P < 0.001). CONCLUSION Because of the reduction in blood folate concentrations associated with the use of oral contraceptives, it is critical for women of childbearing age to continue folate supplementation during oral contraceptive use.
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Affiliation(s)
- Mahvash Shere
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON
| | - Priya Bapat
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON; Department of Pharmacology and Toxicology, University of Toronto, Toronto ON
| | - Cheri Nickel
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON
| | - Bhushan Kapur
- Department of Pharmacology and Toxicology, University of Toronto, Toronto ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ON
| | - Gideon Koren
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto ON; Department of Pharmacology and Toxicology, University of Toronto, Toronto ON
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Coppedè F. The genetics of folate metabolism and maternal risk of birth of a child with Down syndrome and associated congenital heart defects. Front Genet 2015; 6:223. [PMID: 26161087 PMCID: PMC4479818 DOI: 10.3389/fgene.2015.00223] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/10/2015] [Indexed: 11/13/2022] Open
Abstract
Almost 15 years ago it was hypothesized that polymorphisms of genes encoding enzymes involved in folate metabolism could lead to aberrant methylation of peri-centromeric regions of chromosome 21, favoring its abnormal segregation during maternal meiosis. Subsequently, more than 50 small case-control studies investigated whether or not maternal polymorphisms of folate pathway genes could be risk factors for the birth of a child with Down syndrome (DS), yielding conflicting and inconclusive results. However, recent meta-analyses of those studies suggest that at least three of those polymorphisms, namely MTHFR 677C>T, MTRR 66A>G, and RFC1 80G>A, are likely to act as maternal risk factors for the birth of a child with trisomy 21, revealing also complex gene-nutrient interactions. A large-cohort study also revealed that lack of maternal folic acid supplementation at peri-conception resulted in increased risk for a DS birth due to errors occurred at maternal meiosis II in the aging oocyte, and it was shown that the methylation status of chromosome 21 peri-centromeric regions could favor recombination errors during meiosis leading to its malsegregation. In this regard, two recent case-control studies revealed association of maternal polymorphisms or haplotypes of the DNMT3B gene, coding for an enzyme required for the regulation of DNA methylation at centromeric and peri-centromeric regions of human chromosomes, with risk of having a birth with DS. Furthermore, congenital heart defects (CHD) are found in almost a half of DS births, and increasing evidence points to a possible contribution of lack of folic acid supplementation at peri-conception, maternal polymorphisms of folate pathway genes, and resulting epigenetic modifications of several genes, at the basis of their occurrence. This review summarizes available case-control studies and literature meta-analyses in order to provide a critical and up to date overview of what we currently know in this field.
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Affiliation(s)
- Fabio Coppedè
- Section of Medical Genetics, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa Pisa, Italy ; Interdepartmental Research Center Nutrafood "Nutraceuticals and Food for Health," University of Pisa Pisa, Italy
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Tang X, Cleves MA, Nick TG, Li M, MacLeod SL, Erickson SW, Li J, Shaw GM, Mosley BS, Hobbs CA. Obstructive heart defects associated with candidate genes, maternal obesity, and folic acid supplementation. Am J Med Genet A 2015; 167:1231-42. [PMID: 25846410 PMCID: PMC4675451 DOI: 10.1002/ajmg.a.36867] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/17/2014] [Indexed: 01/13/2023]
Abstract
Right-sided and left-sided obstructive heart defects (OHDs) are subtypes of congenital heart defects, in which the heart valves, arteries, or veins are abnormally narrow or blocked. Previous studies have suggested that the development of OHDs involved a complex interplay between genetic variants and maternal factors. Using the data from 569 OHD case families and 1,644 control families enrolled in the National Birth Defects Prevention Study (NBDPS) between 1997 and 2008, we conducted an analysis to investigate the genetic effects of 877 single nucleotide polymorphisms (SNPs) in 60 candidate genes for association with the risk of OHDs, and their interactions with maternal use of folic acid supplements, and pre-pregnancy obesity. Applying log-linear models based on the hybrid design, we identified a SNP in methylenetetrahydrofolate reductase (MTHFR) gene (C677T polymorphism) with a main genetic effect on the occurrence of OHDs. In addition, multiple SNPs in betaine-homocysteine methyltransferase (BHMT and BHMT2) were also identified to be associated with the occurrence of OHDs through significant main infant genetic effects and interaction effects with maternal use of folic acid supplements. We also identified multiple SNPs in glutamate-cysteine ligase, catalytic subunit (GCLC) and DNA (cytosine-5-)-methyltransferase 3 beta (DNMT3B) that were associated with elevated risk of OHDs among obese women. Our findings suggested that the risk of OHDs was closely related to a combined effect of variations in genes in the folate, homocysteine, or glutathione/transsulfuration pathways, maternal use of folic acid supplements and pre-pregnancy obesity.
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Affiliation(s)
- Xinyu Tang
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mario A Cleves
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Todd G Nick
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ming Li
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Stewart L MacLeod
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Stephen W Erickson
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jingyun Li
- Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University Medical School, Palo Alto, California
| | - Bridget S Mosley
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Charlotte A Hobbs
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Liu J, Gao L, Zhang Y, Jin L, Li Z, Zhang L, Meng Q, Ye R, Wang L, Ren A. Plasma folate levels in early to mid pregnancy after a nation-wide folic acid supplementation program in areas with high and low prevalence of neural tube defects in China. ACTA ACUST UNITED AC 2015; 103:501-8. [PMID: 25808729 DOI: 10.1002/bdra.23368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Folic acid supplementation is recommended for all women of child-bearing age to prevent neural tube defects (NTDs). A nation-wide folic acid supplementation program was implemented in rural areas of China since 2009; however, changes in plasma folate levels in pregnant women were unknown. METHODS A cross-sectional survey was conducted in 2011 to 2012, with 1736 pregnant women enrolled, and results were compared with a previous survey in 2002 to 2004. A microbiological method was used to determine plasma folate levels. Preprogram and postprogram median plasma folate concentrations were compared while stratified by prevalence of NTDs and residence. RESULTS In the high NTD prevalence population, plasma folate concentration increased to 33.4 (18.7, 58.4) nmol/L in the postprogram sample, which is 2.9 times of the preprogram. In the low NTD prevalence population, plasma folate increased to 67.9 (44.5, 101.9) nmol/L, which is 1.9 times of the preprogram. Gaps remained in plasma folate levels with respect to prevalence of NTDs and residence. Folic acid supplementation has a strong impact on plasma folate concentrations. Earlier supplementation (before the last menstrual period), increased supplementation frequency and more total days of supplementation were associated with a higher plasma folate concentration as demonstrated in both the high- and low-prevalence populations. CONCLUSION Plasma folate levels among pregnant Chinese women increased dramatically after the nation-wide folic acid supplementation program in both rural and urban areas, and in populations of high and low NTD prevalence. The nation-wide program should have a component to ensure that supplementation begins before pregnancy.
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Affiliation(s)
- Jufen Liu
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lili Gao
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yali Zhang
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lei Jin
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhiwen Li
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Le Zhang
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qinqin Meng
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Rongwei Ye
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Linlin Wang
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Alférez MJ, Rivas E, Díaz-Castro J, Hijano S, Nestares T, Moreno M, Campos MS, Serrano-Reina JA, López-Aliaga I. Folic acid supplemented goat milk has beneficial effects on hepatic physiology, haematological status and antioxidant defence during chronic Fe repletion. J DAIRY RES 2015; 82:86-94. [PMID: 25394837 DOI: 10.1017/S0022029914000624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the current study was to asses the effect of goat or cow milk-based diets, either normal or Fe-overloaded and folic acid supplement on some aspects of hepatic physiology, enzymatic antioxidant defence and lipid peroxidation in liver, brain and erythrocyte of control and anaemic rats after chronic Fe repletion. 160 male Wistar rats were placed on 40 d in two groups, a control group receiving normal-Fe diet and the Fe-deficient group receiving low Fe diet. Lately, the rats were fed with goat and cow milk-based diets during 30 d, with normal-Fe content or Fe-overload and either with normal folic or folic acid supplemented. Fe-overload increased plasma alanine transaminase and aspartate transaminase levels when cow milk was supplied. Dietary folate supplementation reduced plasma transaminases levels in animals fed goat milk with chronic Fe overload. A remarkable increase in the superoxide dismutase activity was observed in the animals fed cow milk. Dietary folate supplement lead to a decrease on the activity of this enzyme in all the tissues studied with both milk-based diets. A concomitant increment in catalase was also observed. The increase in lipid peroxidation products levels in rats fed cow milk with Fe-overload, suggest an imbalance in the functioning of the enzymatic antioxidant defence. In conclusion, dietary folate-supplemented goat milk reduces both plasma transaminases levels, suggesting a hepatoprotective effect and has beneficial effects in situation of Fe-overload, improving the antioxidant enzymes activities and reducing lipid peroxidation.
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De Steur H, Feng S, Xiaoping S, Gellynck X. Consumer preferences for micronutrient strategies in China. A comparison between folic acid supplementation and folate biofortification. Public Health Nutr 2014; 17:1410-20. [PMID: 23507512 PMCID: PMC10282357 DOI: 10.1017/s1368980013000682] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Despite public health efforts, folate deficiency is still largely prevalent in poor, rural populations and continues to cause a large burden of disease. The present paper determines and compares consumer preferences for two folate strategies: folic acid supplementation v. folate biofortification, i.e. the enhancement of the folate content in staple crops. DESIGN Experimental auctions with non-repeated information rounds are applied to rice in order to obtain willingness-to-pay for folate products. Thereby, GM or non-GM folate-biofortified rice (FBR) is auctioned together with rice that is supplemented with free folic acid pills (FAR). SETTING Shanxi Province (China) as a high-risk region of folate deficiency. SUBJECTS One hundred and twenty-six women of childbearing age, divided into a school (n 60) and market sample (n 66). RESULTS Despite differences according to the targeted sample, a general preference for folate biofortification is observed, regardless of the applied breeding technology. Premiums vary between 33·9 % (GM FBR), 36·5 % (non-GM FBR) and 19·0 % (FAR). Zero bidding behaviour as well as the product choice question, respectively, support and validate these findings. The targeted sample, the timing of the auction, the intention to consume GM food and the responsibility for rice purchases are considered key determinants of product choice. A novel ex-post negative valuation procedure shows low consistency in zero bidding. CONCLUSIONS While the low attractiveness of FAR provides an additional argument for the limited effectiveness of past folic acid supplementation programmes, the positive reactions towards GM FBR further support its potential as a possible complementary micronutrient intervention.
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Affiliation(s)
- Hans De Steur
- Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | - Shuyi Feng
- College of Public Administration, Nanjing Agricultural University, Nanjing, People's Republic of China
| | - Shi Xiaoping
- College of Public Administration, Nanjing Agricultural University, Nanjing, People's Republic of China
| | - Xavier Gellynck
- Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
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Jeeja MC, Jayakrishnan T, Narayanan PV, Kumar MSV, Thejus T, Anilakumari VP. Folic acid supplementation on homocysteine levels in children taking antiepileptic drugs: A randomized controlled trial. J Pharmacol Pharmacother 2014; 5:93-9. [PMID: 24799812 PMCID: PMC4008929 DOI: 10.4103/0976-500x.130048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/06/2013] [Accepted: 07/12/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the level of homocysteine (tHcy) in children taking AEDs and to study whether daily oral supplementation of folic acid for 1 month will reduce the tHcy level. MATERIALS AND METHODS This was a double-blinded, randomized control trial conducted in Institute of Maternal and Child Health, Kozhikode, India. Totally 60 children were recruited and of them, 48 were enrolled. Of these children, 32 were assigned to the experimental group and 16 to the control group. Baseline data collection and tHcy estimation were done. One mg folic acid tablets were given to the experimental group and placebo tablets to the control group for 30 days. tHcy levels were re-estimated after 1 month follow-up. Statistical significance was tested by χ(2) test, and paired and unpaired t-tests, as appropriate. Correlation was tested by Pearson correlation test and P value less than 0.05 was taken as the cut-off for statistical significance. RESULTS Baseline plasma tHcy concentrations in both groups were comparable [11.90 (6.3) and 13.02 (2.4) μmol/l, respectively]. During the follow-up period, no increase in seizure episodes or no serious adverse reactions were noticed in either group. The reduction of tHcy in the experimental group was 1.92 μmol/l (P = 0.04) and in the control group, there was an increase of 1.05 μmol/l (P = 0.16). CONCLUSIONS In children on AED treatment, folic acid supplementation may reduce tHcy level and thus reduce CVD risk.
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Affiliation(s)
| | - Thayyil Jayakrishnan
- Department of Community Medicine, Government Medical College, Calicut, Kerala, India
| | | | | | - Thayyil Thejus
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Maher M, Keriakos R. Women's Awareness of Periconceptional Use of Folic Acid Before and After Their Antenatal Visits. Clin Med Insights Womens Health 2014; 7:9-15. [PMID: 24817820 PMCID: PMC4011717 DOI: 10.4137/cmwh.s13535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study is to assess women’s awareness of the benefit and use of folic acid during pregnancy and to assess whether their knowledge has improved following hospital visits. METHOD This is a prospective survey conducted in a large teaching hospital in the UK. The survey questionnaire consisted of 28 questions about demographic variables, behavioral variables, and knowledge about folic acid and neural tube defects (NTDs). RESULT A total of 603 women participated in this study. Some of them attended for the first time and others had more than one visit, either in their current or previous pregnancies. In about 25% of cases, the pregnancy was not planned. Between 14 and 19% of the women of First and Two+ Visit groups consulted their doctor or other healthcare professional before conception. Nearly 98% of the women stated that they had heard of folic acid, but only 42–52% knew the medical condition it protects against. The main sources of information for women who were aware of folic acid were midwives and general practitioners. Nearly 90% of women who attended their first antenatal visit were taking folic acid. However, only 40% of women knew that they should take it before pregnancy, and only between 36 and 46% knew the dietary sources of folic acid, although about 84% know the foods that should be avoided during pregnancy. This study found that attending antenatal clinic has not increased women’s awareness about folic acid. CONCLUSION There is still a high proportion of women who do not know that folic acid should be taken before pregnancy and continued for the first three months of pregnancy. School education, primary care team, and family planning service should take the lead in providing information to women about folic acid.
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Affiliation(s)
- Mark Maher
- King's College London, London, England, UK
| | - Remon Keriakos
- Consultant Obstetrician and Gynaecologist, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, UK
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Veeranki SP, Gebretsadik T, Dorris SL, Mitchel EF, Hartert TV, Cooper WO, Tylavsky FA, Dupont W, Hartman TJ, Carroll KN. Association of folic acid supplementation during pregnancy and infant bronchiolitis. Am J Epidemiol 2014; 179:938-46. [PMID: 24671071 DOI: 10.1093/aje/kwu019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Viral bronchiolitis affects 20%-30% of infants; because there is no known effective treatment, it is important to identify risk factors that contribute to its pathogenesis. Although adequate folate intake during the periconceptional period prevents neural tube defects, animal data suggest that higher supplementation may be a risk factor for child respiratory diseases. Using a population-based retrospective cohort of 167,333 women and infants, born in 1995-2007 and enrolled in the Tennessee Medicaid program, we investigated the association between the filling of folic acid-containing prescriptions and infant bronchiolitis. We categorized women into the following 4 groups in relation to the first trimester: "none" (no prescription filled), "first trimester only," "after first trimester," and "both" (prescriptions filled both during and after the first trimester). Overall, 21% of infants had a bronchiolitis diagnosis, and 5% were hospitalized. Most women filled their first prescriptions after the fifth to sixth weeks of pregnancy, and most prescriptions contained 1,000 µg of folic acid. Compared with infants born to women in the "none" group, infants born to women in the "first trimester only" group had higher relative odds of bronchiolitis diagnosis (adjusted odds ratio = 1.17, 95% confidence interval: 1.11, 1.22) and greater severity (adjusted odds ratio = 1.16, 95% confidence interval: 1.11, 1.22). This study's findings contribute to an understanding of the implications of prenatal nutritional supplement recommendations for infant bronchiolitis.
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