Best time to take folate
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Optimal Timing for Folate Supplementation: Key Insights
Importance of Folate for Neural Tube Defects Prevention
Folate, a B-vitamin, is crucial for DNA synthesis and maintenance, particularly during reproduction. Its role in preventing neural tube defects (NTDs) is well-documented, making it essential for women of childbearing age to maintain adequate folate levels.
Preconception Folate Supplementation
Starting Folate Before Conception
Research indicates that folate supplementation should ideally begin several months before conception. A daily intake of 4 mg folic acid can take up to 20 weeks to achieve optimal red-blood-cell folate levels, which are crucial for reducing the risk of NTDs. Therefore, starting folate supplementation 5-6 months before conception is recommended to ensure adequate folate levels by the time of conception.
Compliance with Recommendations
Despite recommendations, many women do not start folate supplementation early enough. A study found that only 19% of women began taking folic acid before conception, although 84% reported taking it during the first trimester. This delay can result in suboptimal red cell folate concentrations, increasing the risk of NTDs.
Folate Supplementation During Pregnancy
First Trimester Supplementation
The neural tube closes by Day 28 post-conception, making early folate supplementation critical. Women are advised to take 400 µg of folic acid daily from preconception through the first trimester to minimize NTD risk .
Alternative Forms of Folate
Supplementation with [6S]-5-methyltetrahydrofolate ([6S]-5-MTHF) has been shown to be more effective than folic acid in increasing red blood cell folate concentrations. This suggests that [6S]-5-MTHF could be a viable alternative for improving folate status in women of childbearing age.
Folate Supplementation for Women on Phototherapy
Women undergoing phototherapy, which can degrade folate, are recommended to take 0.8 mg/day of folate supplements to mitigate the risk of NTDs in case of unplanned pregnancies.
Weekly Folate Supplementation
In regions where daily supplementation is challenging, weekly folic acid supplementation has been explored. A study in Malaysia is investigating the efficacy of a weekly dose of 2.8 mg folic acid in raising erythrocyte folate concentrations to levels associated with reduced NTD risk.
Conclusion
For optimal prevention of neural tube defects, folate supplementation should begin 5-6 months before conception and continue through the first trimester. Women of childbearing age, especially those on phototherapy or in regions with limited access to daily supplements, should adhere to recommended folate intake guidelines to ensure adequate folate levels. Alternative forms of folate, such as [6S]-5-MTHF, may offer more effective supplementation options.
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