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The Effect of Race and Prenatal Vitamin Use on Red Blood Cell and Plasma Folates throughout Pregnancy
Maulik, Devika
Maulik, Devika
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Abstract
Folate is a known, effective prophylaxis against congenital anomalies during pregnancy. Periconceptional supplementation is recommended, and many governments have implemented folic acid grain fortification to mitigate the prevalence of neural tube defects. However, little is known regarding folate metabolism throughout pregnancy, specifically how it changes over the course of the three trimesters or how supplementation affects folate stores for the duration of pregnancy. Also, the current threshold for folate insufficiency (red blood cell, RBC folate concentration of less than 906 nmol/L) by the World Health Organization (WHO) is based on clinical trial data that likely had limited representation of Black mothers. Not surprisingly, population-level surveillance of repletion strategies suggest that Black mothers continue to have lower folate status regardless of fortification programs. This study aims to characterize folate metabolism in a cohort of racially diverse, normal pregnancies and test the hypothesis that race affects folate status in all three trimesters. This is a cross-sectional analysis of 254 samples from a cohort of normal pregnant women (n=154) . Whole blood and RBC total folates increased from the first trimester to the second and third trimester, in all races; the difference was only statistically significant when comparing RBC folates in each trimester ( p<0.05). 55.93% of mothers in the first trimester mothers but only in 37.50% and 35% of the second and third trimester mothers were insufficient according to WHO criteria(p<0.05). Furthermore, 57% of Black women were insufficient compared to 31.2% of Latina and 27.5% of White women (p<0.001). Despite Black mothers generally having lower folate status in all three trimesters and a greater likelihood of being folate insufficient, they paradoxically have lower rates of neural tube defects. This study suggests that current definitions of folate insufficiency and repletion strategies may not apply to the same extent to the Black community. Future studies may look to reevaluate repletion strategies and parameters of deficiency that are more applicable to differential patient populations, with specific consideration of race.
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2020-01-01
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University of Kansas
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This item contains archived web content.
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Maulik_ku_0099M_17542_DATA_1.pdf
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- Embargoed until 2170-05-31
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Keywords
Obstetrics, Nutrition, Folate, Folic Acid, Pregnancy, Race, Trimester