Folate metabolism pregnancy

Folate deficiency is said to inhibit DNA synthesis, a consequence of which is that the maturation of red blood cells is slowed, causing anemia. As for folate deficiency during pregnancy, this can be the side effect of drugs that interfere with folate metabolism. 

Kl. Kahn, S. B., Fein, S., Rigberg, S., and Brodsky, I., Correlation of folate metabolism and socioeconomic status in pregnancy and in patients taking oral contraceptives. Amer. J. Obstet. Gynecol. 108, 931-935 (1970). 

Many factors affect folate metabolism, including dietary folate level, nutritional status of vitamins B6, B12, and riboflavin, zinc status, alcoholism, and physical states such as pregnancy and lactation. In many cases, the effects of these factors are seen in altered excretion rates of intact folates and metabolites, but the effects on tissue levels of the various folates and transfer rates between tissues are not well understood. Preliminary human and animal kinetic models are being devek ed in our laboratory based on studies conducted under controlled dietary conditions. These models will provide a base from which to study the effects of altered folate nutriture as well as the influence of other factors such as pregnancy and aging on folate metabolism. 

Chango, A., and Abdeimebi-Najar, L., 2011. Folate metabolism pathway and Plasmodium falciparum malaria infection in pregnancy. Nutrition Reviews. 69 34 0. 

Since sulfasalazine inhibits the absorption of folic acid, patients may become folate deficient during longterm therapy. Sulfasalazine decreases the bioavailabiUty of digoxin. Cholestyramine reduces the metabolism of sulfasalazine. Sulfasalazine causes a reversible decrease in sperm counts. Sulfasalazine is safe in pregnancy. 

Because both drugs may interfere with folic acid metabolism, their use during pregnancy is usually contraindicated by the potential for effects on the fetus, such as the development of neural tube defects associated with folate deficiency. The use of trimethoprim is contraindicated in patients with blood dyscrasias, hepatic damage, and renal impairment. 

Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects. 

Folate is involved in one-carbon unit transfer reactions during DNA synthesis, DNA methylation, and amino acid metabolism. Evidence to date shows that maternal dietary intake of folic acid is inversely associated with the risk of neural tube defect-affeeted pregnancies [9,10]. Neural tube defects (a term which includes spina bifida) are anatomieal birth anomalies affecting the brain and the spinal cord. As a result of these landmark findings, the first folic acid fortification program was introduced in the United States during 1998, in an attempt to reduce the prevalence... 

Vitamins are a well-known group of compounds that are essential for human health. Water-soluble vitamins include folate (vitamin B9) to create DNA. Folate also plays an important role in preventing birth defects during early pregnancy. Thiamine is the first vitamin of the B-complex (vitamin Bl) that researchers discovered. It allows the body to break down alcohol and metabolize carbohydrates and amino acids. Like many other B vitamins, riboflavin (vitamin B2) helps the body to metabolize carbohydrates, proteins, and fat. Niacin (vitamin B3) protects the health of skin cells and keeps the digestive system functioning properly. Pantothenic acid (vitamin B5) and biotin allow the body to obtain energy from macronutrients such as carbohydrates, proteins, and fats. Vitamin B6 (pyridoxine) acts as a coenzyme, which means it helps chemical reactions to take place. It also plays a vital role in the creation of nonessential amino acids. 

More than 30 enzymes and three transport proteins are involved in the folate-mediated one-carbon metabolism network (Figure 44.1) (Chango et al. 2009b). The enzyme MTHFR is the most studied of these proteins. A common sequence variant in the gene coding MTHFR has been involved in several different complex diseases, including cardiovascular disease (CVD), neural tube defects, pregnancy complications and cancer. 

Folic acid (folate) is found in green leafy vegetables and is involved in one-carbon metabolism. Folate supplements are vital during pregnancy. Groups of women who are prescribed folic acid show a significant decrease in the incidence of neural tube defects in their newborns (5b). 

The lack of hard evidence about the extent of supplementation required in pregnancy prompted the development of a laboratory-based assessment of metabolic turnover, which involved the assay of total daily folate catabolites (along with intact folate) in the urine of pregnant women. The rationale of the procedure was that this catabolic product represents an ineluctable daily loss of folate, the replacement of which should constitute the daily requirement. Correcting for individual variation in catabolite excretion and the bioavailability of dietary folate, the recommended allowances based on this mode of assessment are in close agreement with the latest recommendations of the USA/Canada and FAO/WHO. The data produced by the catabolite-excretion method may provide a useful adjunct to current methods... 

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