Folic Acid Dosage in Profylactic Treatment during Pregnancy

Abstract

The big reluctance to give prophylactic folic acid during pregnancy is probably, to some extent, due to the possible risk of masking a developing vitamin B12 deficiency and to the fact that pernicious anemia of pregnancy is a very unusual complication (Lowenstein, Pick and Philpott, 1955).Nevertheless, the recent years investigations on folic acid metabolism during pregnancy have shown that a clinical latent folic acid deficiency is common at the end of pregnancy. Thus, Chanarin, MacGibbon, OSulIivan and Mollin (1959) found that 213 of women in the childbearing age group. A high frequency of injected folic acid in late pregnancy. Among others, Hansen and v . KZewesahl (1963) found that at the end of pregnancy almost half of healthy non anaemic pregnant women had serum folic acid values which were below the normal limits for non pregnant women in the childbearing age group. A high frequency of pathological FIGLU tests have also been described (Luhby 1963), and furthermore it has been shown that giant and hypersegmented granulocytes are a very common occurrence in peripheral blood at the end of pregnancy (Hansen 1964, Chanarin, Rothman and Berry 1965, Giles 1966). The relationship between obstetrical complications and a defective folic acid metabolism has also been shown by Hibbard (1964). These new experiences have more or less resulted in a changed attitude to prophylactic folic acid administration and this is also today recommended by many authors.

Scientific Opinion on Dietary Reference Values for folate

“…Afssa (2001) noted that young (non-pregnant) women did not meet the PRI for folate of 300 µg/day (CREDOC, 1999). IOM (1998) set an EAR for pregnancy of 520 µg DFE/day, adding to the EAR for non-pregnant women 200 µg DFE/day based on data from supplementation studies (Dawson, 1966;Willoughby and Jewell, 1966;Hansen and Rybo, 1967). IOM (1998) set an EAR for pregnancy of 520 µg DFE/day, adding to the EAR for non-pregnant women 200 µg DFE/day based on data from supplementation studies (Dawson, 1966;Willoughby and Jewell, 1966;Hansen and Rybo, 1967).…”

“…Several studies investigated the responses of folate biomarkers to supplementation with folic acid in pregnant women but did not assess dietary folate intake of the women (Dawson, 1966;Hansen and Rybo, 1967;Willoughby and Jewell, 1968). Several studies investigated the responses of folate biomarkers to supplementation with folic acid in pregnant women but did not assess dietary folate intake of the women (Dawson, 1966;Hansen and Rybo, 1967;Willoughby and Jewell, 1968).…”

Nutrient Intake Values for Folate during Pregnancy and Lactation Vary Widely around the World

“…Consequently, folate requirements for pregnant women are largely based on findings of population-based supplementation trials conducted in the 1960s [4,126,127,128] and a more recent controlled metabolic study aimed to evaluate the adequacy of the current folate requirements in a group of pregnant women [129]. Estimates generated from these earlier supplementation trials determined that the minimum daily requirement of supplemental folic acid in pregnant women was approximately 100 µg/day [4,126]; however, if megaloblastic anemia was more common in the population ( i.e. , in a population with suboptimal folate intake), a daily supplement of 300 µg folic acid/day was closer to the minimum requirement, particularly in late pregnancy [7,127,128].…”

“…, in a population with suboptimal folate intake), a daily supplement of 300 µg folic acid/day was closer to the minimum requirement, particularly in late pregnancy [7,127,128]. Specifically, Hansen and Rybo [4] demonstrated that while supplementation with 50 µg folic acid/day taken in the last trimester of pregnancy was not sufficient to maintain maternal folate stores, 100 µg folic acid/day was found to be adequate to prevent against a decline in erythrocyte folate concentration, however 15% of study participants had serum folate levels below 2 ng/mL. Willoughby and Jewel [128] found that 100 µg folic acid/day was inadequate to prevent a serum folate concentration below 3 ng/mL in 33% of women compared to only 5% of women supplemented with 300 µg folic acid/day.…”

“…During pregnancy and lactation, the demand for folate is increased to support both the normal physiological changes of the mother and optimal growth and development of the fetus and offspring [2,3]. Observational studies in the 1960s demonstrated higher rates of folate-related anemia (megaloblastic anemia) in unsupplemented pregnant and lactating mothers [4,5,6]. As a result, a number of countries recommended supplementation of folic acid during the prenatal period [7].…”