Poor folate status either 1 month before conception or during the first trimester of pregnancy is an independent risk factor for neural tube defects (NTD) in the newborn. One study has suggested the increased risk could be as high as 10-fold (Daly et al 1995).
Intervention trials for pregnancy have routinely used 400 ¡jg folic acid/day; however, there is some suggestion that routine ingestion of only 100 ¡jg folate from fortified food would prevent the majority of NTDs. Studies have also been conducted on women with a previous NTD birth, with benefits demonstrated at doses of 4 mg/day. There is a general consensus among researchers and health authorities that due to the inconsistent nature of natural food sources, taking a supplement or incorporating fortified foods is the only reliable way to increase levels sufficiently (Cuskelly et al 1996).
Our understanding of folate's role in healthy pregnancies has progressed significantly in the last several years, with the ongoing identification of associated birth defects including Down syndrome (Eskes 2006) and cleft lip and/or palate (Blieka et al 2006). Higher folate levels are linked to the prevention of miscarriages, decreased risk of intrauterine growth retardation, increased birth weight in the offspring of smoking mothers (Sram et al 2005) and increased rates of twin pregnancies, from both natural and IVF conception (Haggarty et al 2006).
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