Maternal folate nutrition and offspring health: evidence and current controversies
Maternal folate nutrition and offspring health: evidence and current controversies
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DOI：
10.1017/s0029665118002689
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发表时间：
2019-05-01
影响因子：
7
通讯作者：
Pentieva, Kristina
中科院分区：
文献类型：
--
作者：
Caffrey, Aoife;McNulty, Helene;Pentieva, Kristina
众所周知，围孕期叶酸 (FA) 对预防神经管缺陷 (NTD) 具有保护作用，因此全球建议在孕前和孕早期补充 FA。整个怀孕期间母亲的叶酸可能对后代健康具有其他作用，包括儿童时期的神经发育和认知表现。叶酸对于 C-1 代谢至关重要，C-1 代谢是涉及核苷酸合成、DNA 修复和甲基化反应等多种生物过程的途径网络。这里审查的证据表明，孕早期母体叶酸营养对后代健康具有决定性作用，并且在妊娠后期可能有益。叶酸介导的与大脑发育和功能相关的基因的表观遗传变化为将母体叶酸与后代大脑的影响联系起来提供了合理的生物学基础，尽管这项研究还处于起步阶段。事实证明，在食品中强制添加 FA 可以非常有效地减少实施人群中的 NTD 病例，但由于担心过度接触 FA 可能产生不利影响，这一政策存在争议。在缺乏全民强化的情况下，并且考虑到目前 FA 建议的遵守情况普遍较差，优化母亲在妊娠早期的叶酸状态以预防 NTD 仍然具有挑战性。因此，英国、爱尔兰和欧洲其他地方目前预防 NTD 的政策（仅基于围孕期 FA 补充）已被证明基本上是无效的。本次审查讨论了围绕该领域的证据和争议，并确定了将政策转化为实践的挑战。
Periconceptional folic acid (FA) is known to have a protective effect in the prevention of neural tube defects (NTD), leading to global recommendations for FA supplementation before and in early pregnancy. Maternal folate throughout pregnancy may have other roles in offspring health, including neurodevelopment and cognitive performance in childhood. Folate is essential for C-1 metabolism, a network of pathways involved in several biological processes including nucleotide synthesis, DNA repair and methylation reactions. The evidence reviewed here shows a conclusive role for offspring health of maternal folate nutrition in early pregnancy and probable benefits in later pregnancy. Folate-mediated epigenetic changes in genes related to brain development and function offer a plausible biological basis to link maternal folate with effects in offspring brain, albeit this research is in its infancy. Mandatory FA fortification of food has proven to be highly effective in decreasing NTD cases in populations where it has been implemented, but this policy is controversial owing to concerns related to potential adverse effects of over-exposure to FA. In the absence of population-wide fortification, and given the generally poor compliance with current FA recommendations, optimising folate status of mothers in very early pregnancy for protection against NTD remains challenging. Thus, current policy in the UK, Ireland and elsewhere in Europe for the prevention of NTD (based on periconceptional FA supplementation only), has proven to be largely ineffective. This review addresses the evidence and the controversies that surround this area, as well as identifying the challenges in translating policy into practice.