Human milk folate and folate status in lactating mothers and their infants

Tamura, Tsunenobu; Yoshimura, Yohzo; Arakawa, Tsuneo

doi:10.1093/ajcn/33.2.193

Cited by 91 publications

(50 citation statements)

References 24 publications

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“…Folate supplementation during lactation is reported to have differing effects on plasma folate. Tamura et al (43) reported plasma folate concentrations to be 7 times greater than at baseline after 4 wk of supplementation with 1 mg folate/d. Women in that study, however, were at different stages of lactation and had an average plasma folate concentration of 13 nmol/L before supplementation.…”

Section: Discussionmentioning

confidence: 99%

Maternal folate status during extended lactation and the effect of supplemental folic acid

Mackey

Picciano

1999

The American Journal of Clinical Nutrition

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Background: Folate requirements during lactation are not well established. Objective:We assessed the effects of dietary and supplemental folate intakes during extended lactation. Design: Lactating women (n = 42) were enrolled in a doubleblind, randomized, longitudinal supplementation trial and received either 0 or 1 mg folic acid/d. At 3 and 6 mo postpartum, maternal folate status was assessed by measuring erythrocyte, plasma, milk, and dietary folate concentrations; plasma homocysteine; and hematologic indexes. Infant anthropometric measures of growth, milk intake, and folate intake were also assessed. Results: In supplemented women, values at 6 mo for erythrocyte and milk folate concentrations and for plasma homocysteine were not significantly different from those at 3 mo. In supplemented women compared with unsupplemented women at 6 mo, values for erythrocyte folate (840 compared with 667 nmol/L; P < 0.05), hemoglobin (140 compared with 134 g/L; P < 0.02), and hematocrit (0.41 compared with 0.39; P < 0.02) were higher and values for reticulocytes were lower. In unsupplemented women, milk folate declined from 224 to 187 nmol/L (99 to 82 ng/mL), whereas plasma homocysteine increased from 6.7 to 7.4 mol/L. Dietary folate intake was not significantly different between groups (380 ± 19 g/d) and at 6 mo was correlated with plasma homocysteine in unsupplemented women (r = Ϫ0.53, P < 0.01) and with plasma folate in supplemented women (r = 0.49, P < 0.02). Conclusions: A dietary folate intake of Ϸ380 g/d may not be sufficient to prevent mobilization of maternal folate stores during lactation.Am J Clin Nutr 1999;69:285-92. KEY WORDSLactation, plasma folate, erythrocyte folate, milk folate, dietary folate intake, plasma homocysteine, women INTRODUCTIONThe B vitamin folate and its coenzymatic forms are essential for one-carbon transfer reactions, which are underlying events for protein, DNA, and RNA biosynthesis. Folate requirements are greatest during periods of growth, development, and reproduction but may not always be met because folate deficiency occurs frequently during these nutritionally vulnerable stages of life. It is estimated that, globally, up to one-third of pregnant and lactating women have some degree of folate undernutrition (1). In the United States alone, Ϸ15% of women show signs of suboptimal folate status as evidenced by low serum and erythrocyte folate concentrations (< 6.8 and < 340 nmol/L, respectively) (2).Substantial evidence now exists establishing a relation between enhanced folate intake during the periconceptual period and the prevention of neural tube defects (3, 4). Neural tube defects are among the most common birth defects in the United States and affect Ϸ1 in 1000 infants (5). Compromised maternal folate status during pregnancy is also linked to low birth weight (6) and abruptio placentae (7) and to disorders that affect maternal health. Low folate status is associated with cellular dysplasia, often the predecessor of cancerous lesions in the epithelial layer of the cervix and c...

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Section: Discussionmentioning

confidence: 99%

Maternal folate status during extended lactation and the effect of supplemental folic acid

Mackey

Picciano

1999

The American Journal of Clinical Nutrition

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“…Serum folate did not differ significantly between breastfed and nonbreastfed children at age 6 mo [56 (95% CI: 53, 60) and 52 (45,59) nmol/L, respectively], at age 12 mo [34 (32,37) and 31 (28,34) nmol/L, respectively], or at age 24 mo [24 (19,29) and 19 (18,20) nmol/L, respectively]. Infants who were breastfed at age 6 mo had significantly lower cobalamin, holoHC, and holoTC and higher MMA and tHcy concentrations than did nonbreastfed infants at age 6 mo (P 0.001 for all).…”

Section: Breastfed Compared With Nonbreastfed Childrenmentioning

confidence: 99%

“…The folate content in breast milk is relatively independent of maternal folate status (32)(33)(34), and breastfed infants are usually well protected against folate deficiency (18,31,35). The bioavailability of folate from breast milk is high, possibly beause of the folate-binding protein, which may facilitate absorption from the gastrointestinal tract (36 -40).…”

Section: Folatementioning

confidence: 99%

Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants

Hay

Johnston

Whitelaw

et al. 2008

The American Journal of Clinical Nutrition

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Background: Folate and cobalamin status changes markedly during infancy. Objective: We aimed to examine the influence of breastfeeding on folate and cobalamin status in healthy infants. Design: In a longitudinal study, we measured serum folate, cobalamin, holotranscobalamin, holohaptocorrin, methylmalonic acid, and homocysteine at birth and at ages 6, 12, and 24 mo (n ҃ 361, 262, 244, and 224, respectively). Breastfeeding status and nutrient intake were assessed by using questionnaires and 7-d weighed-food records (at 12 mo). Results: All indexes changed significantly from birth to age 24 mo (P 0.001). Folate was high until age 6 mo and then declined. At age 6 mo, folate was positively correlated with duration of exclusive breastfeeding ( ҃ 0.29; P 0.001). Cobalamin status declined after birth in breastfed but increased in nonbreastfed infants. Thus, holotranscobalamin (pmol/L) was lower in breastfed than in nonbreastfed children at age 6 mo [geometric x : 37 (95% CI: 33, 40) and 74 (64, 86), respectively], at 12 mo [51 (46, 56) and 76 (70, 82), respectively], and at 24 mo [65 (50, 83) and 90 (85, 97), respectively; P 0.05 for all]. Complementary feeding did not increase (6 mo) or modestly increased (12 mo) cobalamin status in breastfed children. At 12 mo, cobalamin intake (g/d), excluding breast milk cobalamin, was lower in breastfed than in nonbreastfed infants [geometric x : 1.4 (1.3, 1.6) and 2.4 (2.1, 2.6), respectively; P 0.001]. However, after adjustment for total cobalamin intake, cobalamin status (ie, holotranscobalamin) remained significantly lower in breastfed than in nonbreastfed infants [54 (49, 59) and 70 (64, 78), respectively; P 0.001]. Conclusions: Low cobalamin status is a characteristic finding in breastfed children. Reference limits according to age and breastfeeding status should be considered in early childhood.

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“…Several investigations show an increased risk of suboptimal folate status (Matoth et al, 1965;Donangelo et al, 1989;Lehti, 1989;Ramlau-Hansen et al, 2003;Villalpando et al, 2003) and a reduction in folate stores during the lactation period (Shapiro et al, 1965;Tamura et al, 1980;Butte et al, 1981;Sneed et al, 1981;Smith et al, 1983;Dostalova, 1984;Bruinse et al, 1985;Bates et al, 1986;Salmenpera et al, 1986;Keizer et al, 1995;Mackey and Picciano, 1999) in women with no folic acid supplementation and with a diet insufficient in folate. Others have shown that lactation does not affect the level of folate (Cole et al, 1974;Thomas et al, 1980;Ek, 1983).…”

Section: Introductionmentioning

confidence: 99%

Folate and vitamin B12 in relation to lactation: a 9-month postpartum follow-up study

et al. 2005

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Objective: To investigate the relation between lactation and markers of folate and vitamin B12 (B12) deficiency in women with and without vitamin supplementation. Design: A 9-month follow-up study. Subjects and methods: Blood samples from 91 women, who gave birth to a single healthy child, were collected 3 weeks, 4 and 9 months postpartum and analysed for circulating level of homocysteine (tHcy), methylmalonic acid (MMA), folate and B12. The participants were categorized as exclusively, partly or not breast-feeding dependent on the degree of lactation 4 months postpartum. During follow-up, lifestyle factors were recorded by structured interviews. Results: Among 72 exclusively breast-feeding women, the median (10-90% percentile) tHcy was 5.8 (3.1-8.3) mmol/l 3 weeks postpartum, 6.1 (4.1-10.3) mmol/l 4 months postpartum and 5.3 (3.6-8.7) mmol/l 9 months postpartum. At 9 months postpartum, none of the women breast-fed exclusively. No significant change occurred in the concentration of B12 and folate. Exclusively breast-feeding women without vitamin supplementation had higher median tHcy than supplemented exclusively breast-feeding women 4 and 9 months postpartum (7.0 vs 5.4 mmol/l (Po0.001) and 5.8 vs 4.5 mmol/l (P ¼ 0.003), respectively). Six women had increased (415 mmol/l) tHcy; four of these were unsupplemented and exclusively breast-feeding. Conclusion: We found no overall indication of depletion of the folate and B12 stores during the lactation period in this population. However, folate-supplemented women had lower tHcy and higher folate levels, suggesting a beneficial effect of supplementation with folate throughout lactation. Sponsorship: The Biomedical Laboratory Scientist Education and Research Fund and LEO Pharma Research Foundation supported this study. DPC Scandinavia, Denmark donated reagents for the folate and tHcy analysis.

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Human milk folate and folate status in lactating mothers and their infants

Cited by 91 publications

References 24 publications

Maternal folate status during extended lactation and the effect of supplemental folic acid

Maternal folate status during extended lactation and the effect of supplemental folic acid

Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants

Folate and vitamin B12 in relation to lactation: a 9-month postpartum follow-up study

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