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Updated: Jul 14, 2026
Modifying Levels of Maternal Dietary Folic Acid or Choline to Study the Impact of Deficiencies on Offspring Health Outcomes
Published on: June 28, 2024
Red cell folate and plasma homocysteine in preterm infants
1Special Care Baby Unit, Singleton Hospital, Sketty, UK. jyothiee@yahoo.com
Insights
Preterm formula and breast milk fortifiers provide adequate folic acid, eliminating the need for additional supplementation in preterm infants. Total homocysteine (tHcy) levels were within normal adult ranges, but further research is needed for optimal preterm infant levels.
Area of Science:
- Neonatal Nutrition
- Folate Metabolism
- Vascular Health
Background:
- Routine folic acid supplementation is common for preterm infants.
- Increased folic acid intake from specialized formulas and fortifiers necessitates re-evaluation of supplementation needs.
- The role of homocysteine in preterm infant neurological complications is largely unknown.
Purpose of the Study:
- To determine if additional folic acid supplementation is required for preterm infants receiving fortified formulas or breast milk fortifiers.
- To measure red cell folate and plasma total homocysteine (tHcy) levels in preterm infants.
- To explore the potential association between tHcy and adverse outcomes in preterm infants.
Main Methods:
- Red cell folate and tHcy were measured in 28 preterm infants (<34 weeks' gestation) at 1 and 4 weeks of age and before discharge.
- Factors influencing folate and homocysteine status were recorded.
- Measurements were compared to established reference ranges.
Main Results:
- No folate deficiency (<140 ng/ml) was observed; red cell folate levels ranged from 266 to 1,513 ng/ml.
- Red cell folate concentrations showed a trend of increasing with age.
- Plasma tHcy levels (0.8–12.2 micromol/l) were within the normal range for fasting adults.
Conclusions:
- Current preterm formulas and breast milk fortifiers adequately supply folic acid, negating the need for additional supplementation.
- While tHcy levels were comparable to adult ranges, optimal levels for preterm infants require further investigation.
- The study highlights the sufficiency of modern neonatal nutritional practices for folate status.
Background:
The supplementation of preterm infants with folic acid is routine practice in many neonatal units. However, the advent of preterm formula milks and breast milk fortifiers have increased folic acid intake. We measured red cell folate in preterm infants who received preterm formula milks and breast milk fortifiers to determine whether additional folic acid supplementation was still required. A potential benefit of folic acid supplementation is reduction of plasma total homocysteine (tHcy). tHcy appears to have a linear association with the risk of atherothrombotic vascular events in adults but its role in intraventricular haemorrhage and associated white matter damage in preterm infants is not known. As there is little information regarding tHcy in preterm infants, we also measured tHcy in this study.
Methods:
Red cell folate and tHcy were measured at 1 and 4 weeks of age and before discharge in 28 consecutive infants <34 weeks' gestation. Factors which may have affected folate and homocysteine status were recorded.
Results:
Red cell folate ranged between 266 and 1,513 ng/ml and deficiency (<140 ng/ml) was not observed in any sample. Red cell folate concentration tended to increase with increasing age. tHcy ranged from 0.8 to 12.2 micromol/l and fell within the 'normal' range for fasting adults.
Conclusions:
Preterm formula milks and breast milk fortifiers provide sufficient folic acid to prevent folate deficiency in preterm infants. Although tHcy fell within the 'normal' range for fasting adults, more research is needed to determine optimal concentration of tHcy for preterm infants.
