RESUMO

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.

Assuntos

Suplementos Nutricionais , Ácido Fólico , Masculino , Gravidez , Feminino , Humanos , Criança , Estudos de Coortes , Inquéritos e Questionários , Telômero

RESUMO

Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS.

Assuntos

Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Defeitos do Tubo Neural/dietoterapia , Cuidado Pré-Natal , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Gravidez , Adulto Jovem

RESUMO

OBJECTIVE: To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women. DESIGN: A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use. SETTING: The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010. SUBJECTS: Pregnant women (n 6822) enrolled into a nationally generalizable cohort. RESULTS: Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity. CONCLUSIONS: In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.

Assuntos

Suplementos Nutricionais , Ácido Fólico , Comportamentos Relacionados com a Saúde , Gravidez/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Ácido Fólico/administração & dosagem , Ácido Fólico/uso terapêutico , Humanos , Nova Zelândia , Saúde Pública

RESUMO

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.

Assuntos

Suplementos Nutricionais/efeitos adversos , Ácido Fólico/efeitos adversos , Mediadores da Inflamação/sangue , Interleucina-8/sangue , Células Matadoras Naturais , Fator de Necrose Tumoral alfa/sangue , Adulto , Brasil , Feminino , Ácido Fólico/administração & dosagem , Ácido Fólico/sangue , Humanos , Imunidade/efeitos dos fármacos , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/metabolismo , Estado Nutricional , Estudos Prospectivos , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Valores de Referência , Tetra-Hidrofolato Desidrogenase/genética , Tetra-Hidrofolato Desidrogenase/metabolismo , Fator de Necrose Tumoral alfa/genética , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/efeitos adversos , Complexo Vitamínico B/sangue

RESUMO

El aporte de folatos durante el embarazo es esencial para un desarrollo fetal y placentario adecuados y para la salud del individuo a largo plazo. Su deficiencia puede inducir alteraciones y patologías fetales como bajo peso al nacer, recién nacidos de pre término y defectos del tubo neural (DTN). Por ello, varios países han decidido implementar políticas públicas de fortificación de alimentos con ácido fólico (AF). Chile inició la fortificación de la harina de trigo con AF en el año 2000, logrando reducir en un 43% la prevalencia de DTN. Sin embargo, además de la elevada ingesta de pan de nuestra población (principal alimento fortificado con AF), muchas mujeres embarazadas consumen suplementos de AF, lo que podría estar superando las concentraciones máximas de AF recomendadas. Adicionalmente, si la dieta materna es reducida en vitamina B12 (vit B12), se alteraría la razón óptima folatos/vit B12 lo que modificaría la metilación de genes específicos y otras vías metabólicas pudiendo afectar el desarrollo fetal y la salud de los recién nacidos a largo plazo. Creemos que, transcurridos 17 años del inicio de la fortificación de la harina de trigo con AF, es necesario evaluar los posibles efectos secundarios de un alto consumo de AF, no solo durante el embarazo, sino también en la población general. Presentamos antecedentes acerca del mecanismo de acción de folatos y vit B12 a nivel celular, y conceptos actuales sobre las posibles consecuencias de un aporte materno elevado de AF sobre la descendencia.

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Folate intake during pregnancy is essential for an adequate fetal and placental development and for the long time health of the individual. Its deficiency may induce fetal pathologies, including neural tube disease (NTD). Therefore, several countries implemented public policies to fortify foods with folic acid (FA). Chile started the fortification of wheat flour with FA in the year 2000, decreasing a 43% the prevalence of NTD. However, despite the high consumption of bread (the main fortified food with FA) by our population, a high number of pregnant women consume FA supplements, thus, over passing the maximal recommended FA intake. Additionally, if the diet is reduced in vitamin B12, the optimal ratio folates/vit B12 may be altered, thus inducing changes in the methylation of specific genes and other metabolic pathways, affecting fetal development and the long-term health of the neonates. We think that, after 16 years of the initiation of the fortification of wheat flour with FA, it is necessary to evaluate the possible side effects of a high intake of FA in the pregnant population and their offspring. This article shows antecedents about mechanisms of folates and vit B12 at cellular level, and their possible consequences of an elevated FA maternal intake on the offspring.

Assuntos

Humanos , Feminino , Gravidez , Recém-Nascido , Alimentos Fortificados , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Cuidado Pré-Natal/métodos , Vitamina B 12/administração & dosagem , Triticum/química , Pão , Dieta

RESUMO

INTRODUCTION: Pregnancies affected with neural tube defects (NTDs) are mostly associated to maternal deficiency of folic acid (FA). Although supplementation is recommended for all women of childbearing age, the incidence of NTDs in Puerto Rico has not shown a significant decrease. OBJECTIVE: The goal of this study was to assess the awareness and level of knowledge of FA supplementation among women attending prenatal clinics, and correlate this knowledge with the source ofinformation and the actual use of FA. A secondary objective was to corroborate or abrogatethe association of the lack of FA supplementation with the occurrence of unplanned pregnancies. METHODS: This descriptive study was conducted at the High-Risk Prenatal Care Clinicsof the Adults University Hospital from August 2015 to November 2015. The answers to a non-validated self-administered questionnaire were assessed and then analyzed with Epi Info 7. RESULTS: From a total of 200 Hispanic female participants, 87.0% were Puerto Rican, most (69.0%) had an education above high school level and 54.5% had a low-income status. Overall, 66.5% were taking FA at the time of the interview, 77% understood that the best time to start FA supplementation was prior to conception, but only 23% of the participants actually began preconceptional FA intake. Unplanned pregnancies were reported in 70.5%. Most referred to have received information about FA benefits from a healthcare professional, yet many could not identify all of FA benefits. CONCLUSION: Although most participants were aware of the best time to begin FA supplementation, the majority began intake once pregnancy was discovered; timing related to the 70.5% unplanned pregnancies. Information received is not sufficient sincemost women are not entirely clear about the benefits of FA supplementation, despite their source of information. In caring for women of childbearing age, further investigation is required to optimize educational strategies and methodologies.