Dutch researchers report that the risk of emotional problems for children of mothers with folate deficiency during pregnancy was 57% higher than children of mothers with adequate intakes, according to findings published in the American Journal of Clinical Nutrition.
The research adds to the mother and child benefits of folic acid, in addition to the established link at reducing the incidence of neural tube defects (NTDs).
Indeed, the same researchers reported in the British Journal of Nutrition in 2009 that children of women who took folic acid supplements during pregnancy were better at internalizing and externalizing problems, compared to the children of mothers who did not take supplements.
Benefits for babies
An overwhelming body of evidence links has linked folate deficiency in early pregnancy to increased risk of neural tube defects (NTD) - most commonly spina bifida and anencephaly - in infants.
This connection led to the 1998 introduction of public health measures in the US and Canada, where all grain products are fortified with folic acid - the synthetic, bioavailable form of folate.
Preliminary evidence indicates that the measure is having an effect with a reported 15 to 50 per cent reduction in NTD incidence. A total of 51 countries now have some degree of mandatory fortification of flour with folic acid.
Other countries are also considering such fortification measures: In the meantime, recommendations for women of child-bearing age to consume folic acid supplements continue.
The researchers note that the Netherlands, where their study was located, does not currently have mandatory fortification with folic acid, and that women of childbearing age are recommended to take folic acid supplements.
“However, although campaigns to promote folic acid intake in the Netherlands increased supplement use, still about half of the women do not use folic acid supplements in the conceptional period,” they explained.
“Folic acid fortification could improve folate status in women of childbearing age. However, fortification alone would not provide the full requirement.
“It thus remains important to better educate women of childbearing age about folic acid supplement use.”
Data was analyzed for 3,209 children. Maternal folate levels were measured in early pregnancy, and the use of folic acid supplement assessed using questionnaires. The children’s emotional and behavioral problems were assessed with the Child Behavior Checklist at the age of three years old.
Results showed that children of mothers with prenatal folate deficiency were at a 57% higher risk of emotional problems but there was no association with behavioral problems, said the researchers.
The data also revealed that children of mothers who started using folic acid supplements late or did not use supplements at all were at a 45% higher risk of emotional problems, compared with children of mothers who started using supplements around the time of conception.
Source: American Journal of Clinical Nutrition
June 2012, Volume 95, Number 6, Pages 1413-1421, doi: 10.3945/ajcn.111.030791
“Maternal folate status in early pregnancy and child emotional and behavioral problems: the Generation R Study”
Authors: J. Steenweg-de Graaff, S.J. Roza, E.A. Steegers, A. Hofman, F.C. Verhulst, V.W. Jaddoe, H. Tiemeier