Aktivna folna kiselina – važnost u trudnoći

Active folic acid and the appropriate amount folate in recent years, it has been increasingly emphasized as very important for the healthy development of the fetus in pregnant women. What are the importance of folate, why it is especially important to take it into the body before and during pregnancy, and what is the importance of the active form of folic acid during pregnancy, read below. 

Folate for health in pregnancy

Pregnancy is a period in which the body of pregnant women has increased nutritional needs for vitamins, minerals, proteins, but also slightly increased energy needs. One of the key elements for the health of a pregnant woman and the healthy development of a child is folic acid. During pregnancy, the need for folic acid intake is increased, and we are very often not able to get enough of it in our daily diet.

Today, there are many prenatal nutritional supplements available on the market, and what you should definitely pay attention to is which form of folic acid they contain.

Folates and active folic acid

In medical literature, folate is the name for all preparations containing vitamin B9, whether they occur in nature, are added to food, or are synthetically created. Folates were previously called vitamin B9 and folacin.

In the context of vitamin B9, there are 3 different forms of it:

• folate: the form present in food
• folic acid: synthetic form, present in most dietary supplement formulations
• active folic acid: called 5-methyltetrahydrofolate (5-MTHF)

All forms of folate, once metabolized in the intestines, are found in the blood mainly in the form of 5-methyltetrahydrofolate.

With a proper and varied diet in which we consume enough citrus fruits, kale, green leafy vegetables and peas, we can also consume enough folate. However, the reality is somewhat different, the deficit is more and more common and widespread, which is why many countries implement mandatory fortification of food (cereals) with folic acid (USA and Canada).

Research has shown that active folic acid has better characteristics compared to folates, first of all, it is more easily absorbed by our body compared to folates from food. In addition, folic acid has a more stable chemical form, and what is important to remember is that it is not present in nature, i.e. we cannot introduce it into the organism through food, but is only available in synthetic form. Once it has been absorbed in the body, folic acid changes through metabolic reactions into the active form 5-methyltetrahydrofolate, which is the most useful and functional form for the body and is the only form of folate that the human body can fully use.

Possible problems with folate metabolism

The enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), for which almost 50% of the female population has a polymorphism, takes part in the metabolic reactions of converting synthetic folic acid into the biologically active form of folic acid (5-MTHF). When the polymorphism of the MTHFR enzyme occurs, the activity of the enzyme is reduced, and thus the possibility of metabolizing folic acid is reduced. As a result of the polymorphism, these people have an elevated level of homocysteine ​​in the blood and a higher risk of developing neural tube defects during pregnancy.

So, in the mentioned cases, when active folic acid (5-MTHF) is used, the influence of polymorphism in folate metabolism can be avoided, and thus the deficit of this important nutrient in the body of the (future) mother can be prevented.

Folate deficiency in pregnancy - how to avoid it

Lack of folic acid intake during pregnancy is associated with congenital anomalies of the fetus and damage to the neural tube. The most common and most dangerous damage during the development of the central nervous system is damage to the neural tube, and its closure begins between the 3rd and 4th week of pregnancy.

Adequate intake of folate before pregnancy results in healthy fetal development, therefore folic acid supplements are recommended to be consumed at least 3 months before a planned pregnancy to ensure health during pregnancy.

Folates are essential in the synthesis of all new cells, the synthesis of red blood cells, for the normal metabolism of the immune system, reducing the risk of spontaneous abortion, and for stimulating the production of breast milk during breastfeeding.

However, many pregnant women are not aware of the importance of replenishing folate - studies have shown that only 20% of pregnant women in Croatia take folic acid as recommended.

According to the Croatian national recommendations, as well as the recommendations of the World Health Organization, women planning pregnancy should take folic acid supplements at least three months before pregnancy and at least the first three months of pregnancy, in a dose of at least 400 µg per day.

Conclusion

Active folic acid, therefore, plays a key role in pregnancy health because it is important for healthy fetal development. Folates, including active folic acid, have a positive effect on metabolism and cell development, normal functioning of the immune system, and reducing the risk of neural tube damage. Proper intake of folate before and during pregnancy can ensure the health of mother and child, therefore it is recommended to take food supplements with folic acid at least three months before the planned pregnancy and during the first three months of pregnancy, in a dose of at least 400 µg per day. Taking active folic acid can be useful, especially in people who have a polymorphism in the MTHFR enzyme, to avoid a deficiency of this important nutrient during pregnancy.

 

Literature:

1. Scaglione, F., Panzavolta, G. (2014) Folate, folic acid and 5-methyltetrahydrofolate are not the same thing, Xenobiotica. 44, 480-488.
2. Czeizel, A.E., Dudás, I., Vereczkey, A., Bánhidy, F. (2013) Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients. 5, 4760-4775.
3. Molloy, A.M., Kirke, P.N., Brody, L.C., Scott, J.M., Mills, J.L. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. (2008) Food Nutr. Bull. 29, 101-111.
4. Novak Antolič, Ž. et al. (2015) Clinical nutrition in pregnancy, Faculty of Medicine, University of Ljubljana.
5. Taruscio, D. et al. European Recommendations for Primary Prevention of Congenital Anomalies: A Joined Effort of EUROCAT and EUROPLAN Projects to Facilitate Inclusion of This Topic in the National Rare Disease Plans. (2014) Public Health Genomics. 17, 115-123. doi: 10.1159/000360602
6. Cawley, S., Mullaney, L., McKeating, A., McCartney, D., Turner, M.J. (2016) A review of European guidelines on periconceptional folic acid supplementation. Eur. J. Clin. Nutr. 70, 143–154. https://doi.org/10.1038/ejcn.2015.131

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