Guidelines for prenatal care have
come a long way. Over the last century, maternal and fetal health awareness has
dramatically increased with clinical and technological advancements. Curtain
dietary restrictions and supplementation associated with pregnancy have become
common knowledge in our modern society. Folic acid, for example, is commonly
known as an important supplement during pregnancy (Crider, K. S., Bailey, L.
B., & Berry, R. J.,2011). Just last Friday, Welsh and Scottish health
ministers proposed that all flour suppliers throughout the United Kingdom should
be required to fortify their flour products with folic acid. BBC’s article
describes the importance of folic acid supplementation during pregnancy,
especially as a means of promoting proper development and minimizing risk of
congenital birth defects such as spina bifida. In Scotland alone, almost 160
babies were born with neural tube defects between 2007 and 2011. Additionally, following
early detection of variations of spina bifida, about 130 pregnancies were
terminated during this four-year stretch. It has been suggested that the
prevalence of neural tube defects and other developmental abnormalities stem
from insufficient supplies of dietary folic acid. The Department of Health in
Northern Ireland has reported that “83% of women of childbearing age have
folate deficiency.” This concern has directly prompted the proposed government
involvement (Silver, 2017).
Folic acid is the synthetic form of
endogenous folate or vitamin B9. Naturally occurring folate is an essential
vitamin that is obtained through diet typically from leafy greens, egg yolk,
citrus fruits, and various other sources (Crider, K. S., Bailey, L. B., &
Berry, R. J.,2011). Though found in a variety of foods, many pregnant women are
considered folate deficient because of the vitamin’s vital role in DNA
replication, amino acid synthesis, and metabolism. Supplemented folic acid is
activated by several reduction reactions (folic acid à dihydrofolate (DHF) à tetrahydrofolate (THF)). The metabolic
enzyme dihydrofolate rectuctase is responsible for catalyzing the reduction. The
enzyme methylenetetrahydrofolate reductase (MTHFR) then converts THF to the
biologically active methylfolate which plays a key role in purine and
pyrimidine synthesis, DNA methylation, and much more. Interestingly, while the
metabolism of folic acid into its biologically active products is clearly important,
how the vitamin specifically decreases the incidence of neural tube defects is
unknown. Some studies yield caution to over prescribing folic acid since the
exact mechanism remains unclear (Greenberg, J. A., Bell, S. J., Guan, Y., &
Yu, Y. (2011).
Government mandates to fortify
certain foods with folic acid are often met with some pushback for this reason
exactly. Potential long-term effects of supplemented folic acid have not been thoroughly
investigated and more research is required to unveil the systemic mechanisms of
vitamin B9. Even though other manufacturers have already added folic acid to
various foods, advisers have persistently suggested the addition of folic acid
to flour products for 18 years (Silver, 2017). Flour is a widely consumed
product – the potential benefits and
risks of folic acid supplementation would affect a large majority of the
population. Therefore, it is important for government officials to investigate
all considerations and research associated with folic acid fortification.
References:
Crider,
K. S., Bailey, L. B., & Berry, R. J. (2011, March). Folic Acid Food
Fortification—Its
History, Effect, Concerns, and
Future Directions. Retrieved December 03, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257747/
Greenberg,
J. A., Bell, S. J., Guan, Y., & Yu, Y. (2011). Folic Acid Supplementation
and
Pregnancy: More Than Just Neural
Tube Defect Prevention. Retrieved December 03,
Silver,
K. (2017, December 01). Welsh and Scottish health ministers call for folic acid
in
flour. Retrieved December 03, 2017,
from http://www.bbc.com/news/health-42199080
One of the questions this lack of folic acid in the common diet raises for me is the level of access that the common person has to certain foods that are high in this supplement. Here in the United States, it is much cheaper to buy a filling, unhealthy item off of the McDonald's dollar menu than it is to make a salad with organic, healthy products that will keep you full. Maybe if the costs of these folic acid-rich foods are decreased, or accessibility was increased, this idea to prevent defects or other abnormalities could occur more naturally than adding the folic acid to flour.
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