Folic acid is gaining quite a lot of attention, in 2009 I mentioned it with regards the prevention of birth defects, prevention of premature births, low birth weights and also ADHD.  Recently a study (1) has also found that folic acid use pre-pregnancy and in early pregnancy is associated with a reduced risk of congenital heart defects (heart abnormality present from birth) in newborns.

The study scientists(1) looked at over 600 mothers who had delivered infants with heart defects (but without any genetic or related abnormalities).  These were compared to a ‘control’ group.  Folic acid use was associated with a reduced risk of congenital heart disease in infants  “Use of periconceptional folic acid supplements (of at least 400micrograms a day) was related to approximately 20% reduction in the prevalence of any CHD. Given the relatively high prevalence of CHD worldwide, our findings are important for public health” (1)

The authors note that the findings could be very significant since heart related birth defects can be quite common occurring in up to 2 newborns in every 100 worldwide.  When results were further broken down to look at specific heart defects it was found that women taking folic acid supplements had almost a 40% lower risk of having a child with a heart defect involving the septum, a part of the heart which separates one side of the heart from the other, compared to that of the general population (1).  This is a preliminary study but certainly deserves attention.  Further research would be necessary before any firm conclusions could be drawn

Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age.  The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant.  At this early stage this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida.

If you are planning pregnancy or a woman of childbearing age who could fall pregnant it is certainly worth taking a multi-nutrient supplement which contains folic acid.  Specific supplements are available for pregnant women and those planning pregnancy and it is always a good idea to check with your doctor or midwife before starting supplementation.

Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.

(1) van Beynum IM et al.  2009.  Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J. [Epub ahead of print]
Written by Ani kowal

Folate is in the news again, this vitamin of the B group is one that I have often written about especially with regards pregnancy and the prevention of birth defects, as well as links to premature births and low birth weights.  This time researchers (1) have linked low folate during pregnancy and ADHD in the child after birth.

The researchers (1) started their investigation by introducing the fact that good nutrition during pregnancy is really important and has been linked to foetal brain development.  Poor nutrition during pregnancy may adversely affect brian development and contribute to problems in childhood.  The researchers wanted to assess whether maternal folate status and maternal dietary folate intake during pregnancy was linked to brain growth and childhood behavioural difficulties in the children.

The study (1) followed a cohort of women from early pregnancy.  The mothers red blood cell folate levels were measured at 14 weeks of pregnancy and the total folate intake from food and supplements was assessed in early and late pregnancy.  When the children were born their head circumference and body weight were measured and then at the age of 8.75 years old 100 mothers reported on their children’s behaviour.

Lower maternal red blood cell folate levels and lower total folate intake were associated with higher incidence of childhood hyperactivity and problems with peer group at school in the children.  A higher red blood cell folate level was associated with greater head circumference at birth and lower levels of hyperactivity/inattention and peer problems in children.  Authors of the study note that the associations were small but “our data provide preliminary support for the hypothesis that lower folate status in early pregnancy might impair fetal brain development and affect hyperactivity/inattention and peer problems in childhood”.  The study only shows an association and it might be that mothers with a good folate level have overall better diets which impact brain development in foetus.

Previously written about ADHD and the importance of omega 3 fats in particular.  A balanced, healthy diet in pregnancy is vital for many reasons and may prevent a number of conditions.  Eating well and considering a pregnancy-safe multi-nutrient supplement is certainly worth discussing with your midwife or GP.  In a press release (2) the lead author noted:
"Our findings further support the hypothesis that maternal nutrition contributes to an individuals' development, with potential consequences for their behavior later in life."  The long term effects of poor maternal nutrition may even branch out to the child's ability to interact with peers or form social bonds (1,2).  The researchers also found that children born from mothers with a low folate status had a notably smaller head circumference at birth, which may indicate a smaller rate of prenatal brain growth in children adversely affected by low folate levels. The researcher note that the findings indicate a cause for concern among populations where the nutritional health of the mother is low, and women may be less likely to take folate supplements in advance of pregnancy.

(1)Schlotz et al.  2009.  Lower maternal folate status in early pregnancy is associated with childhood hyperactivity and peer problems in offspring. Journal of Child Psychology and Psychiatry, 2009; [Epub] DOI: 10.1111/j.1469-7610.2009.02182.x
(2) Wiley-Blackwell (2009, October 28). Attention-deficit/hyperactivity Problems Associated With Low Folate Levels In Pregnant Women. ScienceDaily. Retrieved October 28, 2009, from http://www.sciencedaily.com/releases/2009/10/091028134631.htm
Written by Ani Kowal

Following a healthy eating regimen during pregnancy is highly important for the health of both mother and unborn child.  A recent study (1) has emphasised that it is important for pregnant women to include plenty of vegetables as part of their diet.  The study found that daily vegetable consumption by pregnant women was associated with a reduced risk of type I diabetes (insulin dependent diabetes) in their children.

The study (1) assessed and followed 5724 infants and looked at the diet their mothers consumed during pregnancy.  The children were given assessments at age 1, 2.5 and 5 years of age for diagnosis of type 1 diabetes (insulin dependent diabetes).  Low daily consumption of vegetables by the pregnant mother (vegetables were eaten 3-5times per week) was associated to an increased risk of type 1 diabetes in the child when compared to a higher vegetable consumption during pregnancy.

In essence the study found that pregnant women who eat vegetables (at least once) every day seem to have children who are less likely to develop type 1 diabetes.  This is only an association study and does not prove that vegetables protect against diabetes but it is informative and further supports the importance of eating well during pregnancy.  In a press release (2) one of the study researchers commented "This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,"  "We cannot say with certainty on the basis of this study that it's the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother's standard of education, do not seem to explain the link," "Nor can this protection be explained by other measured dietary factors or other known risk factors."  It therefore seems plausible that the myriad of nutrients and flavonoids in vegetables are having some kind of action within the growing foetus.

My interest in nutrition prior to, and during, pregnancy started when I was studying for my first degree.  We learned about the work of David Barker who was a researcher at Southampton University.  His hypothesis, which was known as ‘Barker’s hypothesis’ at the time, suggests that maternal diet affects foetal growth and is associated with chronic conditions in the child later in life.  It is suggested that what a pregnant mother consumes during pregnancy might affect the risk of her child developing conditions such as heart disease, stroke and diabetes (3).  This idea is now more widely known as the ‘Developmental Origins of Adult Health and Disease’ hypothesis.  Both over- and under- nutrition and eating during pregnancy can affect the growth and later health, and perhaps weight, of the child (4).  It is important to remember that what you eat during pregnancy not only affects you, the mother, it may also affect the health of the next generation and may directly contribute to cycles of obesity as well as other conditions (4)

As I have mentioned in previous posts relating to pregnancy, if you are pregnant you may wish to consider taking a multi-nutrient supplement specifically designed for pregnant women together with a fish oil (or flaxseed oil) supplement to provide omega 3 fatty acids.  Taking these sorts of supplements may help to make-up for any shortfalls in the diet but cannot be viewed as an alternative to a healthy diet.  Always check with your doctor of health professional before taking any supplements during pregnancy.

(1)Brekke et al.  2009.  Daily vegetable intake during pregnancy negatively associated to islet autoimmunity in the offspring-The ABIS study. Pediatric Diabetes, 2009; DOI: 10.1111/j.1399-5448.2009.00563.x Published Online: 16 Sep 2009
(2) University of Gothenburg (2009, October 27). Vegetables Can Protect Unborn Child Against Diabetes. ScienceDaily. Retrieved October 28, 2009, from http://www.sciencedaily.com/releases/2009/10/091027132422.htm
(3) Barker, D.J.P. (1997). "Maternal Nutrition, Fetal Nutrition, and Disease in Later Life". Nutrition, '13', pg. 807
(4)McMillen C et al.  2009.  Developmental Origins of Adult Health and Disease: The Role of Periconceptional and Foetal Nutrition.  Basic & Clinical Pharmacology & Toxicology.
102 (2): 82 – 89
Written by Ani Kowal

Earlier this year I wrote a couple of posts concentrating on the accumulating evidence which suggests that probiotic (‘friendly’ gut bacteria) supplements may be useful to boost the immune system.  In children, studies have shown that probiotic and prebiotic (food supplement that feeds the good bacteria in the digestive system) supplements may be useful in preventing recurrent ear infections and also the common cold.

A recently published study (1) has found that prebiotic and probiotic supplements, which improve the intestinal bacterial balance, may be particularly important in preventing eczema in susceptible infants.  It has been thought for a while now that modification of the intestinal bacterial balance could be an important approach to preventing allergic disease.  This particular study aimed to look at the prevention of allergic disease in high-risk children (children with parents and/or siblings with allergic conditions).  The probiotic bacteria was given to pregnant mothers of high-risk children, ie where there was a positive family history of allergic disease, and then to the infant children for the first 12months of life.  This was a controlled trial so there were some mothers/children who were given a placebo, they did not receive a probiotic supplement. 

Parental-reported eczema during the first 3 months of life was significantly lower in the intervention group compared with placebo (1).  The authors conclude their study by reporting “This particular combination of probiotic bacteria shows a preventive effect on the incidence of eczema in high-risk children, which seems to be sustained during the first 2 years of life. In addition to previous studies, the preventive effect appears to be established within the first 3 months of life”

If there are allergies in your family and you think that your child may be at risk of developing eczema or asthma then you may consider taking a probiotic and probiotic supplement during pregnancy and also giving an infant probiotic supplement (there are many available) to your baby during the first year to two years of life.  Please talk to your doctor or health professional before beginning a supplement regimen during pregnancy or with an infant child. 

A fairly recent study (2) assessed the safety of feeding probiotic supplements to newborn infants and found that such supplements were safe and seemed to increase resistance to infections during the first 2 years of life.  The study was well designed and began with pregnant mothers who were given either a mixture of probiotics or placebo for 4 weeks before they were due to give birth.  Their babies were given the same probiotics in conjunction with a prebiotic or placebo for 6 months after birth.  925 infants were involved and followed up for 2 years.  During the 6-month supplement intervention, antibiotics were prescribed less often in the prebiotic/probiotic group than in the placebo group and throughout the 2 year follow-up period, infections occurred less frequently in the group receiving these supplements.

Eczema is an inflammatory skin condition thought to be related to other allergies, such as asthma.  Due to the inflammatory nature of the condition it is thought that long chain omega 3 fatty acids may also be particularly useful in treating the condition, I have previously written about this here, as well as in the post relating to asthma.

(1) Niers L et al.  2009.  The effects of selected probiotic strains on the development of eczema (the PandA study).  Allergy.  64(9):1349-58.
(2) Kukkonen K et al.  2008.  Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 122(1):8-12.
Written by Ani Kowal

Folate is one of the B vitamins that I have written about with regards to preventing birth defects, allergies, heart disease, premature births and improving behaviour, mood, fertility and bone health.  On Monday I wrote about folate and age-related hearing loss.  A recently published study (1) has found that women who eat a diet rich in folate seem to have a reduced risk of developing colorectal cancer.

The B vitamin folate is found mainly in green leafy vegetables, asparagus, black-eyed beans and citrus fruits.  It plays an important role in the synthesis and replication of DNA which is why it is crucial in early pregnancy when the cells of the foetus are rapidly dividing, this is also the reason why it may play a role in cancer prevention.  The authors of this study (1) postulate that if folate is not available, or poorly available in the body it can result in ineffective DNA synthesis which may be linked to initiation and progression of colorectal cancer.  It might be that a low folate intake could be contributing to colorectal cancer by making genetic mutations more likely.

The study (1) included 596 individuals with colorectal cancer and 509 individuals who were cancer free, these are known as ‘controls’.  The participants were 30-79 years old.  When the study scientists investigated the diets of the individuals they found that there was a significant relationship between higher dietary folate intake and reduced risk of colorectal cancer in women.  Women who ate the most folate were at about two-thirds lower risk of the disease than women who consumed the smallest amount of the B vitamin.  The study does not prove that folate prevents against cancer but it certainly indicates that further studies into the relationship would be interesting.  Regularly including folate rich foods in the diet seems sensible for all women but especially those of childbearing age.

Women of childbearing age are generally encouraged to take a folic acid supplement, or a multi-nutirent supplement containing folic acid, since it is known that this can prevent spina bifida, a birth defect.  Recent evidence has found that folic acid may also be important during very early pregnancy for a whole host of other reasons too.  It certainly would also seem prudent for women to take a folate supplement or a folate-containing multivitamin daily to ensure adequate amounts.  Recently the BBC (2) reported a story urging women of childbearing age to take folic acid in a bid to prevent birth defects, something I have echoed in my blog posts.  The BBC piece focuses on the fact that many women start to take the vitamin too late.  Many women start to take folic acid once they know that they are pregnant but often this is too late since they may well be 3-6 weeks pregnant before they realise.  Folic acid is very important in the earliest stages of pregnancy and it seems sensible that women take the vitamin pre-conceptionally as a precautionary measure.  As mentioned the vitamin is also linked to reducing premature births, heart defects and allergies.  The story reports that up to 75% of spina bifida cases could be prevented by the mother taking folic acid three months before conception and during pregnancy.

(1)Kim J et al.  2009.  Folate intake and the risk of colorectal cancer in a Korean population. Eur J Clin Nutr. 2009 Sep;63(9):1057-64
(2)Experts urge wider folic acid use.  Eleanor Bradford.  BBC Scotland Health Correspondent  http://news.bbc.co.uk/1/hi/scotland/8232089.stm
Written by Ani Kowal

Back in May I reported the results of a study which found that taking folic acid before pregnancy and during early pregnancy was associated with a reduced risk of premature birth.  A recent study (1) has found that women with high antioxidant levels in their blood seem less likely to give birth prematurely.

The study(1) was a case control study.  It included over 5000 women.  All the women involved in the study had an interview, examination and blood test at week 24-26 of their pregnancy.  Some of the placentas from term and preterm births were also analysed.  There were 207 preterm births in total.  Women with high (above the average) blood plasma concentrations of carotene (both alpha and beta carotene), cryptoxanthin (a type of carotenoid), and lycopene seemed to have a reduced risk of preterm birth.  (I have written about carotenoids a number of times). 

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.  Carotenoids act as antioxidants in the body.  Antioxidants are important to prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage.

This study found that women with higher blood levels of certain carotenoids were less likely to deliver their babies preterm.  In the study, the one-half of mothers-to-be with the highest blood levels of certain carotenoids were 30 percent to 50 percent less likely to deliver prematurely than women with lower levels. The findings do not prove cause-and-effect. There may be other things about women with high carotenoid levels that explain the association with lower preterm-birth risk but the authors conclude that further studies are certainly warranted to investigate the apparent link found in this study.

If carotenoids, or other antioxidants, do help prevent premature delivery, the reasons are not yet entirely clear.  The authors speculate that it could be related to protection from any ill effects of environmental toxins, like air pollution, or exposure to bacteria or other infectious agents.

Eating a healthy diet during pregnancy, and indeed at any time, is crucial.  Ensuring that you achieve the minimum 5 portions of vegetables and fruits daily is a good idea.  Aiming to eat plenty of these foods will mean that antioxidant levels in the body will naturally be high.  In addition, many women may choose to take a multivitamin and mineral supplement specifically designed for use during pregnancy and this may also boost levels of important antioxidants in the body, as well as providing folic acid.

(1)Kramer MS et al.  2009.  Antioxidant Vitamins, Long-Chain Fatty Acids, and Spontaneous Preterm Birth.  Epidemiology. 20(5):707-713.
Written by Ani Kowal

There seems to be a run of research being released at the moment looking at pregnancy and fertility related issues, as you can see from my recent blog posts.  In a recent review paper (1) researchers have estimated that 1.5million fewer babies would be born at low birth weights every year if all pregnant women, worldwide, took vitamin and mineral supplements. 

The lead researcher of the study, Dr Prakesh Shah, stated in a press release (2) that women should start taking vitamin and mineral supplements “as soon as they know they are pregnant”.  Compared with women who took a placebo, women who took multi-nutrient supplements were 19% less likely to have a low birth weight baby.

Low birth weight infants, those born weighing less than 2.5 kilograms (about 5.5 pounds), face a greater risk of health problems that may extend into adulthood. They tend to be more vulnerable to infections during infancy and childhood and may be more likely to have developmental problems in childhood.  As adults they may be at greater risk of diabetes and high blood pressure.  This study (1) found that “Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation”.

Currently, the World Health Organization (WHO) recommends supplementation with folic acid and iron during pregnancy.  However there have been numerous studies showing that a number of different vitamins/minerals may be necessary in early pregnancy for the best outcomes for mother and baby.  In this current study (1) when compared with women taking iron and folic acid only, the researchers found the multi-supplement users had a 17% risk of having a low birth weight baby.  Babies born to women taking multimicronutrient supplements weighed 54 grams more, on average, than babies born to women taking iron and folic acid alone.  The authors of the study suggest that the WHO could consider revisiting their guidelines to recommend multi-nutrient supplements, not just iron and folic acid, for all pregnant women.

The research is limited by the fact that it is a review study of already published data, not an intervention trial.  In addition to this the studies included in the review varied with regards timing, duration, composition of micronutrients, and characteristics of the study populations.  In populations where under-nutrition is common the multi-nutrient supplement may be more helpful than in populations where nutrient rich diets are eaten.  However there is a growing increase in teenage pregnancy here in the UK and often these children are not following a healthy diet and may well be lacking in a number of vitamins and minerals.  In addition to this my previous posts have shown that many nutrients in early and pre pregnancy are associated with better health in mothers and children in Western populations, so it does seem that multi-nutrient supplements could be important for all pregnant women.

Supplements designed especially for pregnant women are widely available, however it is always a good idea to check with your doctor or midwife before taking any supplements during pregnancy.  As mentioned last week – a healthy balanced diet also very important at all times, but especially during pregnancy.

(1)Prakesh S. Shah et al.  2009.   Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis.  CMAJ.  June 9, 180 (12). doi:10.1503/cmaj.081777.
(2)Anne Harding.  Multivitamins best for preventing low birth weight.  08/06/2009.  Reuters Health.  http://www.reutershealth.com/archive/2009/06/08/eline/links/20090608elin005.html
(3) Canadian Medical Association Journal (2009, June 8). Multivitamins In Pregnancy Reduce Risk Of Low Birth Weights. ScienceDaily. Retrieved June 9, 2009, from http://www.sciencedaily.com/releases/2009/06/090608182549.htm

(4)Bhutta ZA & Haider BA.  2009.  Prenatal micronutrient supplementation: Are we there yet?  Commentary.  CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.090652

Written by Ani Kowal

Since I started the week with a focus on the pregnancy related condition preeclampsia I thought it was a good time to mention a recent study (1) that looked at vitamin supplement use in pregnancy to see if there was any association with the risk of having a miscarriage.  

In this study(1), the authors wanted to look at the relationship between use of prenatal vitamins in early pregnancy and the risk of miscarriage.  4,752 women in the US were involved and individual data about vitamin use was collected at a first-trimester interview.  Approximately 95% of participants reported use of vitamins during early pregnancy and a total of 524 women had a miscarriage.  Any use of vitamins during pregnancy was associated with a reduced risk of miscarriage when compared to women who did not take any vitamins.  The researchers found that the risk for miscarriage was 57% lower among women who took vitamins, compared to those who did not.

These results suggest that taking vitamins before pregnancy and during early pregnancy is associated with a reduced risk for miscarriage.  However the study is far from conclusive.  It may well be that women who take vitamins also tend to be more aware of the factors considered important for health and may tend to lead generally healthier lifestyles when compared to women who do not take vitamins, other confounding factors may also be involved.  Further studies are necessary before firm conclusions can be drawn regarding the effects of supplements on miscarriage risk.   

In a press release (2) the lead study author said  "Because miscarriage occurs very early in pregnancy, it is important for women of reproductive age, who may become pregnant, to eat a balanced diet and use vitamins."  Recently I have written a lot about the links between various nutrients such as folic acid, vitamin B12, vitamin D and multivitamins in early pregnancy and pre pregnancy and an apparent reduced risk of various pregnancy related issues in the mother and baby.  Pre-pregnancy and pregnancy is a very important time for healthy living and healthy eating. 

If you are planning a pregnancy eating plenty of vegetables, fruits, nuts/seeds, beans/pulses, fish (especially oily fish such as salmon, trout and mackerel), unprocessed meats and unprocessed/unrefined wholegrains will help to provide an abundance of vitamins, minerals, flavonoids (bioactive plant chemicals),fibre, protein, healthy fats and energy for you and your baby.  If you feel concerned that you may not be eating a consistently nutritious diet then you may wish to consider taking a food-state multi-nutrient supplement specifically designed for use during pregnancy.  An omega 3 supplement could also be helpful, especially if you do not regularly eat oily fish (at least twice a week) or nuts/seeds.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.  For information about miscarriage and support please visit the Miscarriage Association charity website. 

(1)Hasan R et al.  2009.  Self-reported vitamin supplementation in early pregnancy and risk of miscarriage.  Am J Epidemiol. 169(11):1312-8.
(2)Reuters Health press release .  Vitamin Sypplements may lessen miscarriage risk.  Joene Hendry.  Health eLine 05/06/2009.  http://www.reutershealth.com/archive/2009/06/05/eline/links/20090605elin006.html

Written by Ani Kowal

Last week I wrote about folic acid and how it may be associated with a reduced risk of premature birth.  A recently published study (1) has found that folic acid may also reduce the risk of a baby being born with severe congenital heart defects (heart defects present from birth).

The study took place in Quebec, Canada(1).  The researchers wanted to see whether the fortification of food programme, that has been in place since 1998 and has already proved to be effective in preventing neural tube defects, had impacted the incidence of severe congenital heart defects.  The 1998 government policy requires the mandatory fortification of flour in Canada with folate.

The study(1) looked at infants who were born between 1990 – 2005 who had severe congenital heart defects.  The scientists then analysed the data to compare rates of heart defects before and after the food policy was in place.  Among the 1 324 440 births in Quebec between 1990-2005 there were 2083 infants born with severe congenital heart defects.  Analysis of the results showed no change in the birth prevalence of severe birth defects in the nine years before fortification, while in the seven years after fortification there was a significant 6% decrease per year.  The authors of the study conclude that the public health measures to increase folic acid intake in Canada were followed by a decrease in the birth prevalence of severe congenital heart defects. The findings support the hypothesis that folic acid has a preventive effect on heart defects.

According to Raluca Ionescu-Ittu, a PhD candidate on the team, "this decrease is very significant and probably underestimated. During the study period, there was an increase in other factors associated with a higher prevalence of congenital heart defects, so without the fortification we would probably have seen an increase in these defects." (2)

Despite the positive findings the authors of the study stress the need for women of childbearing age, especially those planning a pregnancy, to take folic acid supplements and not rely on food as a source.  The fortification programme was aimed at the general population, women planning a pregnancy need extra folic acid, it is a good idea for pregnant women to take a folate supplement at least three months before becoming pregnant.  Data that I mentioned last week indicates that there are benefits to taking a folate supplement a year prior to conception.  Folic acid seems to have effects on various aspects of embryonic and infant development.  Natural sources of the vitamin, such as green vegetables, might not provide sufficient doses for pregnant women.  Most medical doctors therefore recommend supplements in addition to a healthy diet rich in folic acid. 

As I have previously stressed: it is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates.  A healthy diet really does affect the unborn child, probably in more ways than we currently know through scientific investigation.  It may also be worth to consider taking a broad spectrum multivitamin and mineral food-state supplement specifically designed for pregnancy in order to maintain good levels of all essential nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.

(1)Ionescu-Ittu R et al.  2009.  Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ 2009;338:b1673
(2) McGill University Health Centre (2009, May 14). Folic Acid Effecive In Preventing Congenital Heart Defects, Canadian Research Shows. ScienceDaily. Retrieved May 19, 2009, from http://www.sciencedaily.com¬ /releases/2009/05/090514111404.htm
Written by Ani Kowal

It is well known that women of childbearing age are recommended to take a supplement that contains folic acid, this is due to the fact that folate (folate is the naturally occurring form of folic acid) in very early pregnancy, before most women even know they are pregnant, can reduce the risk of birth defects especially spina bifida.  Unfortunately many women in the UK do not achieve good levels of folate in their daily diets or through supplements.  A concern in the UK is the rising levels of teenage pregnancy, these young women are often not taking nutrient supplements when they get pregnant and their diets may also be lacking in the vitamins, minerals and essential fatty acids that are vital for the developing foetus.

There may be additional benefits to taking folic acid supplements before conceiving a child.  A new study(1) has found that folic acid supplements prior to conception (and in early pregnancy) may help prevent premature births. The study links early and pre-pregnancy folic acid intakes to a reduced risk of premature births.  Prevention of premature birth is very important, infants born early, before 37 weeks of pregnancy rather than the normal 40 weeks, have an increased risk of many health and developmental problems.

It has previously been shown that women who deliver premature babies tend to have lower levels of folate in their blood but this study(1) wanted to look at the effect of folate supplementation on rates of premature birth.  The researchers assessed 34,480 pregnant women, about 20% of these had been taking folate supplements for a year or more before getting pregnant, 36% had been taking them for less than a year and 44% were not taking any supplements at all.  160 of the women delivered their babies before 32 weeks of pregnancy while 1,658 women delivered their babies before 37 weeks.

The data showed that using folate supplements for a year or more was associated with a 70% reduced risk of delivering a baby at 20-28 weeks.  Taking the supplements for less than a year was linked to 50% reduced risk of premature births compared to women who did not take supplements.  For deliveries between 28-32 weeks the risk was 50% lower for women on supplements for a year or longer and 30% lower for those taking supplements for less than a year compared to those women not taking supplements.  There was no relationship between folate supplement use and risk of delivering a baby between 32 and 37 weeks' gestation.  The preventive effects of supplementation were most powerful for preventing the earliest, and hence riskiest, preterm births.

In brief: These findings show that folate supplementation for a year or more before conception is associated with a 50%–70% decrease in early, but not late, spontaneous preterm births and that the longer a woman takes folate supplements before becoming pregnant, the lower her risk of a preterm birth.  The study only shows a possible association between folate supplementation and reduction in the risk of premature birth.  Further randomised trials are necessary to provide confirmation of the link.  It could be that taking supplements is a general marker for healthy behaviour.  However, there is a body of evidence that suggests there could be biological reasons why folate may protect against premature birth.  Low folate levels are associated with increased intrauterine infection which is linked to early premature births.  Folate also seems to reduce inflammation within the body during pregnancy.  Since folate is necessary preconceptionally and in the early weeks of pregnancy in order to prevent birth defects it is definitely worth considering long term supplementation prior to conception.

It is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates.  It may also be worth considering a broad-spectrum food-state supplement specifically designed for pre-pregnancy in order to main good levels of all nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.

(1) Bukowski et al.  2009.  Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study. PLoS Medicine. 6 (5): e1000061 DOI: 10.1371/journal.pmed.1000061

Written by Ani Kowal

In March I wrote about the link between following a Mediterranean style diet and the risk of having a baby affected by spina bifida.  The study (1) that I mentioned found that mothers following a Mediterranean style diet seemed to have a reduced risk of having a baby affected by the condition.  Spina bifida is a birth defect, known as a neural tube defect, that occurs when the spinal cord fails to close completely. The research seemed to show that folate (folic acid) and vitamin B12 may be of particular importance to expectant mothers.  Folic acid supplementation is now recommended to all women planning to get pregnant and during the early stages of pregnancy since supplementation has been shown to prevent the condition.  However, folate is not the only protective nutrient to consider, a healthy diet as a whole is very important for all individuals especially pregnant women, folate is simply one major factor.

Neural tube defects are birth defects that affect the brain and spinal cord.  They can lead to a lifelong disability or in some cases death. The two most common ones are spina bifida and anencephaly, a fatal condition in which the brain and skull do not develop normally.

In a recently published study (2) the relationship between vitamin B12 and neural tube defects was investigated.  Vitamin B12 works with folate in the body and these vitamins are important for several biochemical reactions as well as with the synthesis and formation of healthy DNA.  Vitamin B12 is particularly important for red blood cell and nerve cell formation.  The study looked at a group of Irish women since Ireland has a high rate of neural tube defects.

The study involved around 1,200 women (2) who gave blood samples during early pregnancy, these were analysed to determine vitamin B12 levels.  Mothers of children affected by a neural tube defect had significantly lower blood levels of vitamin B12 than those women who had children not affected.  Women with the lowest levels of vitamin B12, compared with the highest, were on average 2-3 times more likely to be the mother of a child affected by neural tube defect.  Women with the very lowest levels of vitamin B12, those who showed clinical deficiency of the vitamin, were five times more likely to have a baby with a neural tube defect than those women with the highest levels of vitamin B12

The authors conclude that deficient or inadequate maternal vitamin B12 status is associated with a significantly increased risk for having a child affected by neural tube defects.  The results were independent of the maternal levels of folic acid, showing that B12 was important in it’s own right (2).

Most women are already aware of the importance of folic acid (folate) for the prevention of spinal bifida, the authors of this new study hope that awareness of the importance of vitamin B12 for the further reduction of the risk of neural tube defects also increases among women of childbearing age. 

Although the researchers noted that their results needed to be confirmed by other studies among other populations of women they suggest that women of childbearing age ensure they get enough vitamin B12 in order to prevent deficiency or inadequate levels at the start of pregnancy.  It is critical that women consider their nutritional status before they become pregnant since the developmental events that are involved with neural tube defects occur in the first four weeks of pregnancy, once a women realises that she has become pregnant it is often after this crucial 4 week timeframe.

Vitamin B12 is found in virtually all meat products, dairy products, eggs, fish, shellfish and fortified breakfast cereals.  It can also be found in certain algae and seaweeds.  The recommended nutrient intake (RNI) in the UK for adults aged 19-64 is 1.5 micrograms (µg) per day (or 0.0015mg per day).

Women who eat meat, fish or dairy foods regularly should be able to get enough vitamin B12 from their diet.  However, because vitamin B12 isn't found in vegetable foods vegans and vegetarians who do not regularly consume dairy foods might not get enough of this important vitamin.  For more information vegans and vegetarians may wish to visit the vegetarian and vegan foundation website and read the fact sheet on vitamin B12.  Individuals suffering from intestinal disorders such as inflammatory bowel disease may also have inadequate levels of vitamin B12 since these kinds of conditions often prevent the absorption of sufficient amounts of the vitamin.  In such cases it may be wise to visit a doctor to discuss the use of regular vitamin B12 supplements.

Any woman who is planning a pregnancy and who is concerned that she is not eating a consistently healthy diet rich in vegetables, fruits and healthy fats may wish to consider taking a broad-spectrum food-state supplement specifically designed for pregnancy in order to main good levels of all nutrients, this kind of supplement should contain a good level of vitamin B12.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take a supplement please discuss your thoughts with a GP, nurse or midwife.

(1) Vujkovic M et al.  2009.  The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG.  116(3):408-15
(2)Molloy AM et al.  2009.  Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. 
Pediatrics. 123(3):917-23.

Written by Ani Kowal