Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues

Abstract

Inadequate folate status in women of reproductive age (WRA) can lead to adverse health consequences of public health significance, such as megaloblastic anemia (folate deficiency) and an increased risk of neural tube defect (NTD)‐affected pregnancies (folate insufficiency). Our review aims to evaluate current data on folate status of WRA. We queried eight databases and the World Health Organization Micronutrients Database, identifying 45 relevant surveys conducted between 2000 and 2014 in 39 countries. Several types of folate assays were used in the analysis of blood folate, and many surveys used folate cutoffs not matched to the assay. To allow better comparisons across surveys, we attempted to account for these differences. The prevalence of folate deficiency was >20% in many countries with lower income economies but was typically <5% in countries with higher income economies. Only 11 surveys reported the prevalence of folate insufficiency, which was >40% in most countries. Overall, folate status data for WRA globally are limited and must be carefully interpreted due to methodological issues. Future surveys would benefit from using the microbiologic assay to assess folate status, along with assay‐matched cutoffs to improve monitoring and evaluation of folic acid interventions, thus informing global efforts to prevent NTDs.

The Antagonism of Folate Receptor by the Integrase Inhibitor Dolutegravir: Developmental Toxicity Reduction by Supplemental Folic Acid

“…Furthermore, as more human cohort data is generated, or additional clinical studies are performed on DTG, biological interactions and clinical correlations between natural folate intake, folic acid fortified diets, supplemental folate, calcium intake, and resultant DTG, folate, and calcium in blood and serum and should be investigated. It has been previously reported that in human populations where folate fortification is in place, the prevalence of folate deficiency is approximately 0.1% or 1 per 1,000 individuals, but in unfortified population, the base line incidence may be > 20%, 1 in 5, or possibly higher 54 . This 100 to 200-fold difference in the incidence of folate deficiency lowers the average serum folate, increases NTD risk, and may also increase the risk of NTDs associated with early gestational in utero DTG exposure.…”

Early childhood anaemia more than doubles the risk of developmental vulnerability at school‐age among Aboriginal and Torres Strait Islander children of remote Far North Queensland: Findings of a retrospective cohort study

“…Some characteristics are as recorded on health service data collections: mother's usual residence, ethnicity, parity, smoking in pregnancy; child's sex, gestational age at birth, birth weight, method of birth. Criteria to define derived variables including maternal age, body mass index (BMI), anaemia before and during pregnancy, insufficient red cell folate levels (folate status less than optimal for women of reproductive age to prevent neural tube defects) and prematurity and birth weight category of the children are detailed in Table S2. Birth weight z‐scores for babies with gestational age of 33 weeks or more, were calculated using the INTERGROWTH‐21ST Neonatal Size Calculator …”

The use of non-contraceptive effects of COC with metapholine in women with functional menstrual cycle disorders

“…Для населения, проживающего на территории РФ, характерным является круглогодичный полигиповитаминоз, что обусловлено преобладанием в рационе углеводной пищи и недостаточной культурой употребления овощей и фруктов. По данным Федерального исследовательского центра питания и биотехнологий, повседневный рацион здоровых взрослых людей не обеспечивает адекватное поступление витаминов [16]. Между тем недостаточная обеспеченность организма витаминами рассматривается, с одной стороны, как один из факторов риска развития ряда заболеваний, а с другой, как фактор, который может существенно отягощать течение имеющихся заболеваний.…”

“…Несмотря на использование стратегии фортификации, диверсификации и сапплементации, проблема остается актуальной. Уровень содержания фолиевой кислоты в эритроцитах ниже 906 нмоль/л и 5-МТГФ ниже 748 нмоль/л выявлен более чем у 20% женщин репродуктивного возраста (от 16-18 до 44-49 лет) США и Канады, более чем у 65% женщин Ирландии и Новой Зеландии, более чем у 75% женщин Великобритании и у 100% женщин Швеции [16]. В Германии уровень содержания в эритроцитах фолиевой кислоты выше 906 нмоль/л выявлен только у 9,6% женщин репродуктивного возраста [17].…”