Folate status in women of childbearing age with obesity: a review.

Silvia Maffoni,Fatima Cody Stanford,Rachele De Giuseppe,Hellas Cena

doi:10.1017/s0954422417000142

Silvia Maffoni, Fatima Cody Stanford + Show 2 more

Open Access

https://doi.org/10.1017/s0954422417000142

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Abstract

Several studies have described a positive association between elevated BMI and birth defects risk. Data on plasma concentration of folate in pregnant women with obesity have shown values far below those recommended, regardless of diet, while folate levels should increase before pregnancy to reduce neural tube defects. We report a descriptive review of the most recent studies (from 2005 to 2015) to evaluate folate status through a population of women of childbearing age affected by obesity. The literature contains few studies, which present conflicting results regarding folate status in non-pregnant women of childbearing age affected by obesity, and it appears that there is a modification in folate metabolism, with a reduction in plasma folate levels and an increase in erythrocyte folate uptake. In conclusion, the folate status in women of childbearing age should be assessed by both plasma and erythrocyte levels to start a personalised and more adequate supplementation before conception. Further studies need to be conducted in a larger population, which take into account variables that can affect folate metabolism, such as dietary intake, lifestyle and genetic factors, oral contraceptives or other drug use, previous weight-loss programmes, or a history of bariatric surgery.

Highlights

Adequate dietary folate intake is essential for meeting the requirements for the functioning of the human body[1].Neural tube defects (NTD), well-known consequences of folate deficiency, are the second most common cause of serious birth defects and affect 0·2–10 per 1000 established pregnancies worldwide
It has been demonstrated that maintaining plasma folate levels >15·9 nmol/l and erythrocyte folate levels >906 nmol/l significantly reduces the incidence of NTD[3,4]
The latest scientific evidence suggests that an erythrocyte folate concentration above 1000 nmol/l is required for optimal NTD prevention[2]

Summary

Introduction

Adequate dietary folate intake is essential for meeting the requirements for the functioning of the human body[1]. Neural tube defects (NTD), well-known consequences of folate deficiency, are the second most common cause of serious birth defects and affect 0·2–10 per 1000 established pregnancies worldwide. There is a heavy burden of illness for both the mother and her offspring, with lifelong clinical and economic consequences, which may be prevented with adequate dietary folate intake[2]. In 1960s, the link between folate deficiency during pregnancy and fetal NTD emerged for the first time. The latest scientific evidence suggests that an erythrocyte folate concentration above 1000 nmol/l is required for optimal NTD prevention[2]. A recent meta-analysis evaluated the impact of maternal plasma folate levels during pregnancy on DNA methylation in newborns, which identified differences between genes implicated in various developmental abnormalities other than NTD[5]

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