Aktivna folna kiselina – važnost u trudnoći

Aktivna folna kiselina i odgovarajuća količina folate posljednjih je godina sve više isticana kao veoma važna za zdrav razvoj fetusa u trudnica. Koje su to važnosti folata, zašto ih je posebno bitno prije i tijekom trudnoće unositi u organizam te koja je važnost aktivnog oblika folne kiseline u trudnoći, pročitajte u nastavku.

Folate for health in pregnancy

Trudnoća je razdoblje u kojem tijelo trudnica ima povećane nutritivne potrebe za vitaminima, mineralima, bjelančevinama, ali i blago povišene energetske potrebe. Jedan od ključnih elemenata za zdravlje trudnice i zdrav razvoj djeteta jest folna kiselina. Tijekom trudnoće su potrebe unosa folne kiseline povišene, a svakodnevnom prehranom vrlo često ju nismo u mogućnosti unijeti u dovoljnoj količini.

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

U medicinskoj literaturi, folat je naziv za sve preparate koji sadrže vitamin B9, bilo da se pojavljuju u prirodi, da su dodani hrani ili pak sintetski stvoreni. Folati su se ranije nazivali vitamin B9 pa i folacin.

U kontekstu vitamina B9 postoje 3 njegova različita oblika:

• folat: oblik prisutan u hrani
• folna kiselina: sintetski oblik, prisutan u formulacijama većine dodataka prehrani
• 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.

Odgovarajućim unosom folata prije trudnoće postiže se zdrav razvoj fetusa, stoga se dodatke prehrani s folnom kiselinom preporuča konzumirati najmanje 3 mjeseca prije planirane trudnoće kako bi se osiguralo 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

Aktivna folna kiselina, dakle, igra ključna je za zdravlje u trudnoći  jer je važna za zdrav razvoj fetusa. Folati, uključujući aktivnu folnu kiselinu, imaju pozitivan utjecaj na metabolizam i razvoj stanica, normalno funkcioniranje imunološkog sustava te smanjenje rizika od oštećenja neuralne cijevi. Pravilnim unosom folata prije i tijekom trudnoće može se osigurati zdravlje majke i djeteta, stoga se preporučuje uzimanje dodataka prehrani s folnom kiselinom već najmanje tri mjeseca prije planirane trudnoće i tijekom prvih tri mjeseca trudnoće, u dozi od najmanje 400 µg na dan. Uzimanje aktivne folne kiseline može biti korisno, osobito kod osoba koje imaju polimorfizam u enzimu MTHFR, kako bi se izbjegao deficit ovog važnog hranjivog sastojka tijekom trudnoće.

 

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