Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 30:e63 2007
DOI: 10.2337/dc07-0200
© 2007 by the American Diabetes Association
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Capel, I.
Right arrow Articles by Corcoy, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Capel, I.
Right arrow Articles by Corcoy, R.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Online Letters: Observations
Online Letters

What Dose of Folic Acid Should Be Used for Pregnant Diabetic Women?

Ismael Capel, MD1 and Rosa Corcoy, MD, PHD1,2

1 Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
2 CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain

Address correspondence to Ismael Capel, Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret, 167-08025, Barcelona, Spain. E-mail: icapelf{at}santpau.es

It is well established that folate requirements increase during pregnancy and that supplementing 0.4 mg folic acid/day to the general pregnant population is beneficial in terms of reducing the risk of neural tube defects (NTDs). Offspring of women with pregestational diabetes mellitus have an increased risk of congenital anomalies, including NTDs (1). In animal models, folic acid supplementation reduces glucose-induced congenital anomalies with a threshold effect (2). In humans, the protection afforded by folic acid supplementation against diabetes-associated birth defects is not clear: multivitamin supplements have been reported to reduce the risk of congenital anomalies, but the composition of the supplements was unknown and the benefit probably included that of overall prepregnancy care (3). In recent years, several academic societies (4,5) have recommended high doses of folic acid (4–5 mg/day) to diabetic pregnant women, based on their risk of congenital malformations. As folic acid–tolerable upper intake level is 1 mg/day, the aforementioned recommendations should be considered in the pharmacological range. High doses of folic acid can aggravate B12 vitamin deficiency and promote neoplasia (6), with diabetic women being at high risk (7). On the other hand, most diabetic women, even when planning pregnancy, do not take any folic acid supplement (8). We suggest that large efforts be made to ensure that, as one of the interventions of comprehensive prepregnancy care, diabetic women receive at least the folic acid dose recommended for the general population. When using high doses, we must take into account that they are in the pharmacological range, that there is no evidence of their benefit as a primary prevention strategy in diabetic pregnancy, and that side effects are potentially serious.

References

  1. Becerra JE, Khoury Mj, Cordero JF, Erickson JD: Diabetes mellitus during pregnancy and the risk for specific birth defects: a population-based case-control study. Pediatrics 85:1–9, 1990[Abstract/Free Full Text]
  2. Wentzel P, Gäreskog M, Eriksson UJ: Folic acid supplementation disminishes diabetes- and glucose-induced dysmorphogenesis in rat embryos in vivo and in vitro. Diabetes 54:546–547, 2005[Abstract/Free Full Text]
  3. Correa A, Botto L, Liu Y, Mulinare J, Erikson JD: Do multivitamin supplements attenuate the risk for diabetes-associated birth deffects? Pediatrics 111:1146–1151, 2003[Abstract/Free Full Text]
  4. ACOG Committee on Practice Bulletins: ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists: number 44, July 2003 (replaces committee opinion number 252, March 2001). Obstet Gynecol 102:203–213, 2003[Medline]
  5. Wilson RD, Davies G, Desilets V, Reid GJ, Summers A, Wyatt P, Young D, Genetics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada: The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 25:959–973, 2003[Medline]
  6. Kim YI: Will mandatory folic acid fortification prevent or promote cancer? Am J Clin Nutr 80:1123–1138, 2004[Abstract/Free Full Text]
  7. Rapp K, Schroeder J, Klenk J, Ulmer H, Concin H, Diem G, Oberaigner W, Weiland SK: Fasting blood glucose and cancer risk in a cohort of more than 140,000 adults in Austria. Diabetologia 49:945–952, 2006[Medline]
  8. Roland JM, Murphy HR, Ball V, Northcote-Wrightt J, Temple RC: The pregnancies of women with type 2 diabetes: poor outcomes but opportunities for improvement. Diabet Med 22:1774–1777, 2005[Medline]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Capel, I.
Right arrow Articles by Corcoy, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Capel, I.
Right arrow Articles by Corcoy, R.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum