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Folic acid
SCIENCE UPDATE CNM, PhD
Cara J. Krulewitch,
SCIENCE UPDATE
Prior issues of Science Update have focused on racial and ethnic disparities and a wide range of issues in women’s health. This issue will highlight two pregnancy-related issues that have moved to the forefront of the news and then focus on two recent reports issued by the Surgeon General. First, an update on a past discussion regarding the four-fold disparity between whites and African-American women in pregnancy-related deaths in the United States discussed an earlier issue (1). A recent report (2) analyzed pregnancy-related deaths for Hispanic, Asian/Pacific Islander and American Indian/Alaska Native women and found that these groups represented 16% of all reproductive age women but accounted for 23.5% of all live births. Pregnancy-related death among these groups was lower than blacks but ranged 1.4 to 1.7 times greater than whites. New 2000 census estimates project that these groups will represent approximately 25% of females of reproductive age by 2025. Since these findings indicate they are at higher risk for pregnancy-related conditions, attention must also focus on these ethnic groups as interventions are planned. Further exploration of the heterogeneity within these ethnic groups will be considered since there are variations in outcomes among Hispanic and Asian/Pacific Islander groups. Analysis of American Indian/Alaska Natives would require separation into over 500 different tribal communities. The report recommends looking further into pregnancy-related illnesses, particularly those that require hospitalization using existing systems such as the Pregnancy Risk Assessment Monitoring System. These surveillance approaches may provide the clues that will allow health care providers to reduce maternal health disparities in the future. 1. Science Update. J Midwifery Womens Health 2001 Mar/Apr;46(2):88 –90. 2. Division of Reproductive Health, NCCDPHP. Pregnancy-Related Deaths Among Hispanic, Asian/Pacific Islander and American Indian/Alaska Native Women—United States, 1991–1997. MMWR 2001;50(18):361– 4.
IN THE NEWS Folic Acid In 1998, the March of Dimes dedicated money to a campaign to promote folic acid use among all women of childbearing age. A recent media campaign used pictures of female celebrities with a caption that noted they were not pregnant but were taking folic acid in case they may become pregnant. Current research has expanded the potential benefits of folic acid supplementation beyond the prevention of neural tube defects to other birth defects including cleft lip and palate. Folate is necessary for the conversion of homocysteine to methione. Elevated homocysteine levels have been implicated in the development of cleft palate and lip as well as neural tube defects (1). The same mechanism has been linked to protection for cardiovascular events in people with abnormally high homocysteine levels (2). For more information go to: http://www.modimes.org/Programs2/FolicAcid/Health_Professionals.htm 1. Mills JL, Kirke PN, Molloy AM, Burke H, Conley MR, Lee YJ, et al. Methylenetetrahydrofolate reductase thermolabile variant and oral clefts. Am J Med Genet 1999;86:71. 2. de Jong SC, Stehouwer CDA, van den Berg M, Geurts TW, Bouter LM, and Rauwerda JA. Normohomocysteinaemia and vitamin-treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with premature peripheral arterial occlusive disease: a prospective cohort study. J Intern Med 1999;246:87.
Breastfeeding There are many known immediate and short-term benefits of breastfeeding, however a recent study indicates that the effects may also extend further in childhood. This study indicates that breastfeeding may have a minor impact on reducing the risk of childhood overweight. Data from the Third National Health and Nutrition Examination Survey (1988 –1994) included interviews of the mothers of children aged three to five years old. Details on feeding (breast or bottle), including duration and frequency, were collected 302
Journal of Midwifery & Women’s Health • Vol. 46, No. 5, September/October 2001
Cara J. Krulewitch,
SCIENCE UPDATE
Prior issues of Science Update have focused on racial and ethnic disparities and a wide range of issues in women’s health. This issue will highlight two pregnancy-related issues that have moved to the forefront of the news and then focus on two recent reports issued by the Surgeon General. First, an update on a past discussion regarding the four-fold disparity between whites and African-American women in pregnancy-related deaths in the United States discussed an earlier issue (1). A recent report (2) analyzed pregnancy-related deaths for Hispanic, Asian/Pacific Islander and American Indian/Alaska Native women and found that these groups represented 16% of all reproductive age women but accounted for 23.5% of all live births. Pregnancy-related death among these groups was lower than blacks but ranged 1.4 to 1.7 times greater than whites. New 2000 census estimates project that these groups will represent approximately 25% of females of reproductive age by 2025. Since these findings indicate they are at higher risk for pregnancy-related conditions, attention must also focus on these ethnic groups as interventions are planned. Further exploration of the heterogeneity within these ethnic groups will be considered since there are variations in outcomes among Hispanic and Asian/Pacific Islander groups. Analysis of American Indian/Alaska Natives would require separation into over 500 different tribal communities. The report recommends looking further into pregnancy-related illnesses, particularly those that require hospitalization using existing systems such as the Pregnancy Risk Assessment Monitoring System. These surveillance approaches may provide the clues that will allow health care providers to reduce maternal health disparities in the future. 1. Science Update. J Midwifery Womens Health 2001 Mar/Apr;46(2):88 –90. 2. Division of Reproductive Health, NCCDPHP. Pregnancy-Related Deaths Among Hispanic, Asian/Pacific Islander and American Indian/Alaska Native Women—United States, 1991–1997. MMWR 2001;50(18):361– 4.
IN THE NEWS Folic Acid In 1998, the March of Dimes dedicated money to a campaign to promote folic acid use among all women of childbearing age. A recent media campaign used pictures of female celebrities with a caption that noted they were not pregnant but were taking folic acid in case they may become pregnant. Current research has expanded the potential benefits of folic acid supplementation beyond the prevention of neural tube defects to other birth defects including cleft lip and palate. Folate is necessary for the conversion of homocysteine to methione. Elevated homocysteine levels have been implicated in the development of cleft palate and lip as well as neural tube defects (1). The same mechanism has been linked to protection for cardiovascular events in people with abnormally high homocysteine levels (2). For more information go to: http://www.modimes.org/Programs2/FolicAcid/Health_Professionals.htm 1. Mills JL, Kirke PN, Molloy AM, Burke H, Conley MR, Lee YJ, et al. Methylenetetrahydrofolate reductase thermolabile variant and oral clefts. Am J Med Genet 1999;86:71. 2. de Jong SC, Stehouwer CDA, van den Berg M, Geurts TW, Bouter LM, and Rauwerda JA. Normohomocysteinaemia and vitamin-treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with premature peripheral arterial occlusive disease: a prospective cohort study. J Intern Med 1999;246:87.
Breastfeeding There are many known immediate and short-term benefits of breastfeeding, however a recent study indicates that the effects may also extend further in childhood. This study indicates that breastfeeding may have a minor impact on reducing the risk of childhood overweight. Data from the Third National Health and Nutrition Examination Survey (1988 –1994) included interviews of the mothers of children aged three to five years old. Details on feeding (breast or bottle), including duration and frequency, were collected 302
Journal of Midwifery & Women’s Health • Vol. 46, No. 5, September/October 2001