葉酸

プリン、チミジル酸の生合成に必須の補酵素。Vit.Bのグループ。

葉酸製剤:PteGlu1、ロイコボリン

葉酸拮抗剤:MTX、抗痙攣剤(ジフェニルヒダントイン、フェノバルビタール、ピリミドン)

葉酸の投与量(CDC)

妊娠中の女性は0.4mg/日、

神経管欠損児の分娩既往のある女性は、4mg/日を摂取すると神経管欠損症の70%程度が防止できる。


妊娠期の鉄+葉酸補給、子どもの知的・運動機能向上

妊娠期微量栄養素補給の無作為化比較試験に参加した女性の子ども676 人(7-9歳)を対象に、知的・運動機能の追跡調査を実施。

ビタミンA単独群に比べ、鉄+葉酸群の女性の子どもは知能・実行機能・運動機能検査スコアが有意に優れていた。鉄+葉酸+亜鉛群および14種微量栄養素群とビタミンA単独群に有意差はなかった。

Prenatal Micronutrient Supplementation and Intellectual and Motor Function in Early School-aged Children in Nepal


    1. Parul Christian, DrPH;

    2. Laura E. Murray-Kolb, PhD;

    3. Subarna K. Khatry, MBBS, FRCS;

    4. Joanne Katz, ScD;

    5. Barbara A. Schaefer, PhD;

    6. Pamela M. Cole, PhD;

    7. Steven C. LeClerq, MPH;

    8. James M. Tielsch, PhD

Author Affiliations

    1. Author Affiliations: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Drs Christian, Murray-Kolb, Katz, and Tielsch and Mr LeClerq); Departments of Nutritional Sciences (Dr Murray-Kolb), Educational and School Psychology and Special Education (Dr Schaefer), and Psychology (Dr Cole), Pennsylvania State University, University Park; and Nepal Nutrition Intervention Project–Sarlahi, Nepal Eye Hospital Complex, Kathmandu, Nepal (Dr Khatry and Mr LeClerq).

JAMA. 2010;304(24):2716-2723

Abstract

Context

Iron and zinc are important for the development of both intellectual and motor skills. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children's later functioning.

Objective

To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy.

Design, Setting, and Participants

Cohort follow-up of 676 children aged 7 to 9 years in June 2007–April 2009 who had been born to women in 4 of 5 groups of a community-based, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial.

Interventions

Women whose children were followed up had been randomly assigned to receive daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A, vs a control group of vitamin A alone from early pregnancy through 3 months postpartum. These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation.

Main Outcome Measures

Children's intellectual functioning, assessed using the Universal Nonverbal Intelligence Test (UNIT); tests of executive function, including go/no-go, the Stroop test, and backward digit span; and motor function, assessed using the Movement Assessment Battery for Children (MABC) and finger-tapping test.

Results

The difference across outcomes was significant (Bonferroni-adjusted P < .001) for iron/folic acid vs control but not for other supplement groups. The mean UNIT T score in the iron/folic acid group was 51.7 (SD, 8.5) and in the control group was 48.2 (SD, 10.2), with an adjusted mean difference of 2.38 (95% confidence interval [CI], 0.06-4.70; P = .04). Differences were not significant between the control group and either the iron/folic acid/zinc (0.73; 95% CI, −0.95 to 2.42) or multiple micronutrient (1.00; 95% CI, −0.55 to 2.56) groups. In tests of executive function, scores were better in the iron/folic acid group relative to the control group for the Stroop test (adjusted mean difference in proportion who failed, −0.14; 95% CI, −0.23 to −0.04) and backward digit span (adjusted mean difference, 0.36; 95% CI, 0.01-0.71) but not for the go/no-go test. The MABC score was lower (better) in the iron/folic acid group compared with the control group but not after adjustment for confounders (mean difference, −1.47; 95% CI, −3.06 to 0.12; P = .07). Finger-tapping test scores were higher (mean difference, 2.05; 95% CI, 0.87-3.24; P = .001) in the iron/folic acid group.

Conclusion

Aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent.