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March 24, 2014

(Medical Xpress)—Women who are pregnant or trying to fall pregnant and taking a folic acid supplement may be at risk of reducing their folate benefit through sun exposure, a new Queensland University of Technology study has warned.

In a paper titled "Exposure to solar ultraviolet radiation is associated with decreased folate status in women of childbearing age", published in the Journal of Photochemistry and Photobiology B:Biology, QUT researchers found UV exposure significantly depleted folate levels.

Professor Michael Kimlin and Dr David Borradale, from QUT's AusSun Research Lab, said the study of 45 young healthy women in Brisbane aged 18 to 47, showed high rates of sun exposure accounted up to a 20 per cent reduction in folate levels.

"This is concerning as the benefits of folic acid are well-known, with health professionals urging young women to take a folic acid supplement prior to and during pregnancy," Professor Kimlin said.

"Folate has been found to reduce miscarriage and neural tube defects such as spina bifida in unborn babies. The NHMRC recommends pregnant women or those planning a pregnancy take 500 micrograms a day."

Professor Kimlin said the study, which was the first to investigate the effects of sun exposure on folate levels in women of childbearing age, found women who had high levels of sun exposure had folate levels below those recommended for women considering pregnancy.

"The women at risk were those who were outside during the most UV intense time of the day, between 10am and 3pm, with little sun protection," Professor Kimlin said.

"These were the women who had the highest levels of sun exposure and the lowest levels of folate, whilst not deficient in folate, they were on the lower side of normal."

Dr Borradale said in showing the link between UV exposure and folate depletion, further research including a controlled clinical trial was needed.

"We are not telling women to stop taking folate supplements, but rather urging women to talk to their doctor about their folate levels and the importance of folate in their diet, especially those who are planning a pregnancy," Dr Borradale said.

"The results of this study reinforce the need for adequate folate levels prior to and during pregnancy."

What is folate and how can I get it?

Folic acid is a B vitamin that is very important for pregnant women and those planning a baby. Folate is found in foods such as green leafy vegetables like spinach, citrus fruits, legumes, whole grains and vegemite. Folic acid is also added to many foods such as breads, flours and pastas. Folic acid can also be taken as a pill.

December 11, 2013

Groundbreaking research published in the journal Cell (September 2013) suggests that folic acid deficiency may have detrimental health consequences for several generations.1 This underscores the importance of getting enough folic acid, especially for women of childbearing age who could become pregnant.

Working in collaboration, researchers from the Universities of Calgary and Cambridge (UK) discovered that a mutation in a gene needed for folic acid metabolism, led to developmental abnormalities in several generations of mice. While this study looked at genes, researchers believe that folic acid deficiency in the diet could have a similar multi-generational impact on health in humans.

We have known for some time that folic acid deficiency in women of childbearing age can cause severe developmental problems, including spina bifida, heart defects and placental abnormalities, in their immediate offspring. In this animal study, researchers were surprised by the longer term effects they found. They suggest that the great or great-great grandchildren of a parent who has a folic acid deficiency may have developmental disorders and health problems as a result.

Researchers used mice in this study because the way they metabolize folic acid is similar to humans and because mutations in the same genes or folic acid deficiency result in similar developmental problems in mice. Prior to this study, little was known about how folic acid deficiency led to the wide range of health problems associated with it. This new study shed light on the role of folic acid (known as folate in the form that is naturally found in food) during development.

Their study showed that the detrimental health effects of a genetic mutation in one generation may be passed down to future generations through a process known as epigenetics – that turns genes on and off. Abnormalities in future generations may occur as a result of the wrong genes being turned on or off.
While the aim of this study was to understand how a specific genetic mutation would affect folate metabolism, the findings suggest that a lack of folate in the diet may have even more far-reaching consequences than previously recognized.

Health authorities around the globe, including Health Canada have taken steps to fortify certain foods in the food supply with folic acid. In Canada, white flour, enriched pasta, and enriched corn meal are fortified with folic acid. The results of this study indicate that it may take several generations for the full benefits of the folic acid fortification that was implemented in Canada in 1998 to be realized.

The findings also reinforce how important it is for all women who could become pregnant to take a multivitamin containing 0.4 mg of folic acid every day, as recommended by the Public Health Agency of Canada. To help reduce the risk of neural tube defects, women should start taking the vitamin supplement at least three months before they get pregnant and continue throughout the first three months of pregnancy. Since some women have different needs, it’s always best to talk to your health care professional to find the supplement that is best for you.

A healthy balanced diet before and throughout pregnancy, with plenty of food sources of folate is also vital to help promote optimal health in both mother and baby. Keep in mind that women of childbearing age who could become pregnant need both food sources and a supplement to meet daily needs for folic acid.

Food sources of folate include vegetables and fruit (especially green and orange), legumes, eggs, nuts, and grain products made with enriched wheat flour. For example, eggs are a good source of folate. Two large eggs (i.e. a Food Guide serving) naturally provide 30% of the Daily Value for folate. Women who could become pregnant are encouraged to eat well with Canada’s Food Guide.

See how your intake of food sources of folate measures up.

Learn more about Folate for good health at every age.

To read more about the research, visit: http://research4kids.ucalgary.ca/news/research-published-journal-cell and
http://www.cam.ac.uk/research/news/folic-acid-deficiency-can-affect-the-health-of-great-great-grandchildren

Reference
1. Padmanabhan N et al. Mutation in Folate Metabolism Causes Epigenetic Instability and Transgenerational Effects on Development. Cell, 2013; 155 (1): 81-93.

 

December 01, 2013

A study led by McGill researcher Sarah Kimmins suggests that the father’s diet before conception may play an equally important role in the health of their offspring. It also raises concerns about the long-term effects of current Western diets and of food insecurity.

Here are three links to information on this latest discovery

https://www.mcgill.ca/newsroom/channels/news/you-are-what-your-father-eats-231995

http://www.cbc.ca/news/technology/birth-defect-risk-affected-by-father-s-diet-study-suggests-1.2458179

http://www.ctvnews.ca/health/your-dad-s-diet-before-your-conception-may-have-affected-your-health-study-1.1583385

 

 

September 24, 2013

Overall risk of problems like spina bifida called low, but experts advise women to discuss prescription opioid use with doctor. Read more...

 

August 12, 2013

British experts are testing whether a new supplement taken in early pregnancy could cut the risk of defects including spina bifida.

Women are already urged to take folic acid during the first three months of pregnancy to reduce the chance of a baby suffering neural tube defects. But data suggests folic acid cannot prevent occurrence of all these conditions and some disorders appear to be unresponsive to it.

Now, a team from the research arm of Great Ormond Street Hospital is investigating whether women could take a single daily pill combining the new supplement and folic acid.

One reason why folic acid may not always work is that a genetic "blockage" occurs affecting how it is metabolised in cells. The new supplement includes nucleotides, which are able to bypass this blockage, boosting the effect of folic acid and ensuring the growth of crucial cells.

Tests in mice with the new supplement resulted in an 85% drop in the incidence of neural tube defects. Some conditions that are currently unresponsive to folic acid were also prevented.

Nicholas Greene, professor of developmental neurobiology at the Institute of Child Health (ICH), which is the research partner of Great Ormond Street, said: "We are still in the early stages of this research, but we hope that these promising results in mice can eventually be replicated with human neural tube defects. If it is found to be effective, this nucleotide treatment could boost the effects of folic acid and offer expectant mothers an even more reliable safeguard against relatively common defects like spina bifida."

Neural tube defects affect around one in 1,000 babies in the UK every year and occur if there is a problem with the normal development of the nervous system.

At around 28 days after fertilisation, the developing spinal cord is an open tube but this usually closes. If this process does not occur correctly, spina bifida can result, potentially causing learning difficulties, disability or even an exposed spinal cord.

The Department of Health recommends women take a daily supplement of 400 micrograms of folic acid (also known as vitamin B9) while trying to conceive and for the first 12 weeks of pregnancy. Prof Greene said that, for now, women should continue to take folic acid supplements.

The study, published in the journal Brain, was funded by the Wellcome Trust, Medical Research Council and Newlife Foundation for Disabled Children.

 

February 13, 2013

By taking folic-acid supplements in early pregnancy, women may be able to significantly reduce the chances of their children developing autism, new research suggests. Read the full article

 

 

February 04, 2013

On March 13, 2013, Albert De Greve will turn 90. Albert lives in a retirement home in Sint-Niklaas (Belgium).

He has a low lesion spina bifida and no hydrocephalus. Not having hydrocephalus saved his life, because in those early days, there was no treatment for it. Children with hydrocephalus were left to die. Is Albert the oldest person living with Spina Bifida?

Are you, or do you know anyone, older, please send an email to renee.jopp@ifglobal.org and skean@sbhao.on.ca.

 

July 04, 2012

By Muiris Houston

ANALYSIS: A large study on 11,000 infants will raise international interest and stimulate debates on how best to respond

THE FINDING of a significant link between poor folic acid intake and the development of cleft lip and palate (CLP) underlines the value of long-term health research in the Republic.

The Growing Up in Ireland study, a national project led by Trinity College Dublin and the Economic and Social Research Institute (ESRI), is collecting data on more than 11,000 babies and follows them as they grow older. It is producing a rich vein of original data which can be mined and explored by various researchers.

While it had been thought likely that folic acid had a role beyond that of the developing neural tube and the risk of spina bifida, previous research had failed to establish any significant linkage.

Indeed, a recent Cochrane review of the effect of folic acid on cleft lip or cleft palate found insufficient evidence to support the protective effect of folic acid. This was largely owing to insufficient numbers of cases of the defect occurring in the trials.

There is a higher than normal prevalence of CLP among pregnant women taking drugs that work against folic acid in the body, such as the anti-epilepsy agents phenytoin and phenobarbitone – an association which has long hinted at folic acid having a role in preventing CLP.

But now this large study, to be published in the British Journal of General Practice, has put the issue beyond doubt. The results will cause a ripple internationally and are likely to stimulate debate among public health specialists and general practitioners about how best to respond.

It’s a major coup for TCD’s department of public health and primary care. And the substantial long-term funding provided by the Department of Health, through the Office of the Minister for Children, must be acknowledged.

By mining the data, research student Dervla Kelly and her colleagues hit a rich seam of information connecting expectant mothers’ folic acid intake and the prevalence of CLP.

A cleft lip is a separation in the upper lip, while a cleft palate is an opening in the roof of the mouth.

Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy. A cleft lip and palate occurs in approximately one in 700 live births. Cleft lip, with or without cleft palate, is most frequent in boys and isolated cleft palate is most common in girls.

The condition causes significant morbidity: the effects on an individual’s speech, hearing and appearance, along with psychological effects, can lead to long-lasting adverse outcomes for health and wellbeing.

Even when repaired, complications such as persistent ear infections, speech impairments, facial deformities and dental problems often persist.

Now there is an opportunity to prevent at least some cases of CLP. A daily folic acid tablet of 0.4mg taken four weeks before conception and in the first 12 weeks of pregnancy will reduce the risk of CLP by a factor of four, representing a major reduction in future morbidity.

However, there are a number of challenges to be overcome. It is estimated that up to 50 per cent of pregnancies in Ireland are unplanned, thereby denying these women the opportunity to take supplements pre-conceptually. In addition, for those planning pregnancy, it is not unusual for a baby to reach six weeks of gestation before the pregnancy is confirmed.

This opens up the old chestnut of food supplementation for the wider population. Fortifying bread with folic acid has been mooted here before.

With this new evidence of the additional benefits of folic acid, we can expect a public debate on the pros and cons of mandatory food additives. As water fluoridation has proved, these debates are rarely boring.

May 23, 2012

Most doctors and dietitians would agree that pregnancy is not the time to diet. Moms-to-be who restrict calories also deprive their developing babies of much needed nutrients.

Yet according to a new study published last week in the online edition of the BMJ, dieting during pregnancy is beneficial for some women. Controlling calories was safe and protected from a number of pregnancy-related complications.

Women who are obese during pregnancy have a greater risk of early delivery, gestational diabetes, high blood pressure and pre-eclampsia. (Also called toxemia, pre-eclampsia is marked by the onset of high blood pressure, protein in the urine and swelling (edema) after 20 weeks into pregnancy. If left untreated, it can progress to potentially life-threatening eclampsia.) For the baby, maternal obesity is a risk factor for childhood obesity.

Obesity is on the rise among women of childbearing age. What’s more, it’s estimated that as many as 40 per cent of women exceed the recommended weight gain during pregnancy.

Given these statistics, it’s important to find ways to help women manage their rate of weight gain during pregnancy.

The current study – the largest to date – combined the results of 44 randomized controlled studies conducted in more than 7000 women that investigated the impact of diet, exercise, or both on maternal and fetal outcomes related to weight.

The studies in the analysis mostly involved women who were obese and overweight. Five trials also enrolled women who were diagnosed with gestational diabetes during their pregnancy. (Gestational diabetes increases a woman’s future risk of Type 2 diabetes.) The researchers looked at how much weight women gained during pregnancy and whether mother or child experienced any complications.

While all three methods – diet only, exercise only, or the two combined – reduced a woman’s weight gain, diet had the greatest effect. Compared to women who were not assigned to a diet or exercise group (the control group), mothers-to-be prescribed a personal diet had an average reduction in weight gain of nearly 8.8 pounds (4 kg).

Exercise only resulted in an average reduction in weight gain of 1.5 pounds. A combination of diet and exercise produced an average reduction of 2.2 pounds.

Dietary advice was provided by registered dietitians and was based on limiting overall calories, balancing protein, carbohydrate and fat, and eating unprocessed foods such as whole grains, fruits, vegetables, beans and lentils. Calorie intake was individualized to the needs of the mother. The women also kept a daily food diary.

Women who followed a calorie-controlled diet were also 33 per cent less likely to develop pre-eclampsia compared to controls. As well, the risk of gestational diabetes was 60 per cent lower, the risk of gestational high blood pressure was 70 per cent lower, and the risk of early delivery was 32 per cent reduced.

There’s concern that limiting calories – and nutrients – during pregnancy can result in low birth weight, putting a baby at risk for infection, developmental delays and health problems later in life.

Babies born under 5.5 pounds are considered low birth weight babies. Low birth weight can result when babies are born early (before 37 weeks gestation), are small for their gestational age, or both.

In the study, however, the babies’ birth weights were not affected by controlling calorie intake.

The current findings show that by carefully advising women on diet during pregnancy, excess weight gain can be prevented, helping to reduce the risk of complications for mother and baby.

Nutrition is a critical component to a healthy pregnancy. The following strategies are important to protect the health of both moms-to-be and their developing babies.
 

Monitor weight gain

Weight gain guidelines during pregnancy are based on a woman’s body mass index (BMI) before pregnancy. Women with a healthy pre-pregnancy BMI (18.5-24.9) are advised to gain 25 to 35 pounds.

Women who are overweight (BMI 25 – 29.9) should gain 15 to 25 pounds while obese women (BMI 30 or greater) should gain only 11 to 20 pounds.

Women with a BMI of less than 18.5 are advised to gain 28 to 40 pounds. Use an online calculator to determine your BMI.

If you’re concerned about gaining too much or too little weight during pregnancy, consult with a registered dietitian who can design a meal plan customized to meet calorie needs.

Take folic acid

All women who could become pregnant, who are pregnant, or who are breastfeeding should take a daily multivitamin with 0.4 to 1 milligram of folic acid, a B vitamin that’s vital to preventing neural tube defects (NTDs) in the developing fetus.

NTDs are serious birth defects caused by the incomplete development of the brain, spinal cord and/or their protective coverings that occurs around the fourth week of pregnancy.

Taking a multivitamin during pregnancy may also guard against low birth weight and childhood cancer in offspring including leukemia, brain tumours and neuroblastoma.

Pregnant women should also add folate-rich foods to their diet such as lentils, black beans, cooked spinach, broccoli, asparagus, avocado, and artichokes.
 

Increase iron

During pregnancy daily iron requirements increase from 18 to 27 milligrams. Choose a multivitamin with 16 to 27 milligrams of iron.

Iron-rich foods include beef, shrimp, sardines and trout, legumes, pumpkin seeds, enriched breakfast cereals, nuts, raisins and prune juice.

Women who are iron-deficient or who are vegetarians may require additional iron.
 

Get omega-3 fats.

I advise my pregnant clients to eat five to 12 ounces of oily fish each week to increase their intake of DHA, an omega-3 fat important for brain and eye development during pregnancy and breastfeeding.

Fish rich in omega-3’s and low in mercury include salmon, trout, sardines, herring and Atlantic mackerel.

Women who don’t eat fish should consider taking a fish oil supplement. Vegetarian DHA supplements are also available.

Leslie Beck, a Toronto-based dietitian, is the national director of nutrition for Body Science Centers, medical clinics focusing on healthy aging (BSC5.com).
 

May 22, 2012

by JANET ST. JAMES / WFAA.com

KENNEDALE, Texas — Two-month-old Kellen has eyes only for mommy, and not because she gladly put herself in mortal peril in order to give him the best chance at life.

When Claire Davis was 19 weeks pregnant, she and husband Justin Davis learned more than the gender of their third child.

"I could kind of sense that something was up, because the sonogram technician was taking a really long time, and this was not our first rodeo," Claire said. "I knew what to expect going in there, and it was not what I expected. Then it really was not what I expected."

"It" was spina bifida, the most common permanently disabling birth defect in the United States. About 1,500 babies are born with spina bifida annually, according to the Centers for Disease Control.

Taking folic acid before and during pregnancy has been shown to reduce the incidence of spina bifida, though no one knows for sure what causes the defect.

Even hearing the words "spina bifida" prompts shivers of fear in expectant mothers.

An MRI scan of baby Kellen shows the developmental defect at the bottom of his spine, which is open and exposed to amniotic fluid.

"We think that the damage is due to the spinal cord elements being exposed to the untrauterine amniotic fluid and also the baby moving around," explained Dr. Darrell Cass, a fetal surgeon at Texas Children's Hospital in Houston. "We think that that contributes to ongoing damage."

Common complications of spina bifida include paralysis and brain damage.

"All the potential complications that go along with spina bifida... I was definitely scared," Justin Davis said.

Then, the Davises learned about a hopeful — but dangerous — surgery possible in Houston, one that could correct the spine before the baby is ever born.

"Losing Kellen," Claire paused. "That would've been awful. But going into it, you try not to think of it too much."

In an operating room at Texas Children's Fetal Center, Claire Davis was put under a deep anesthetic.

Doctors then cut the uterus open, like a C-section, and manipulated the baby's exposed spine through the opening in the uterus. A surgeon operated on the baby through that tiny space, closing the spine, and tightly sealing the uterus shut.

"And then — very importantly — we have to close that uterus up, with stitches and keep it pregnant and keep the baby inside the uterus," Dr. Cass said. "And we have to have it so it doesn't leak that amniotic fluid and that the pregnancy can continue, and that's where this becomes very tricky and pretty difficult."

"So by closing these lesions, we're hoping to prevent ongoing injury, and hopefully preserve neurologic function," said Texas Children's OB/GYN Dr. Michael Belfort. "And even in some cases, we believe it's possible to regain some neurologic function."

Children born with spina bifida can have their spines enclosed just after birth. By then, the damage can already be serious.

Many children with spina bifida develop hydrocephalus, water that must be drained from the brain. That condition can cause complications, including serious infections.

The in-utero surgery is very risky, but could help children avoid the most serious complications of spina bifida.

An MRI taken post-surgery showed Kellen's spine was sealed and his brain was developing normally. He now has just a scar to show for the operation.

"He is perfect," his proud mother and father said. "He is wonderful."

Kellen does have two club feet, a common condition for spina bifida babies. Kellen's are being corrected with casts.

In fact, his little legs are so strong, he's already kicked his casts off once. It's an inconvenience that makes his parents smile, considering he could have been born paralyzed.

Now, his parents have hopes they will one day see Kellen running with his brother and sister.

"[I hope] that he be able to walk, run, play," Justin said. "Do everything he's supposed to do."