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Understanding Folate and Miscarriage: A Guide for Fertility Patients

Miscarriage is a devastating experience for millions of women worldwide, with the vast majority occurring for unknown reasons. As healthcare practitioners, it is essential to guide our fertility patients in understanding the role of folate in preventing miscarriage and identifying genetic polymorphisms that may impact folate metabolism. In this article, we will explore the importance of folate and genetic testing in fertility patients and offer guidance on folate supplementation to reduce the risk of miscarriage.

Re-cap on Folate Metabolism

Folate is an essential B-vitamin that plays a critical role in DNA synthesis and cell growth. Folate is naturally found in leafy green vegetables, beans, and other foods, and it is also commonly added to processed foods in the form of folic acid. However, many individuals may have difficulty converting folic acid into active forms of folate, leading to unmetabolised folic acid in the bloodstream.

Genetic Polymorphisms Affecting Folate Metabolism

Several genetic polymorphisms can impact folate metabolism, including DHFR, MTHFS, MTHFD/1, MTHFR, and SHMT. Individuals with these polymorphisms may have difficulty converting folic acid into active forms of folate, leading to a deficiency in this critical nutrient. Genetic testing can help identify these polymorphisms and guide folate supplementation strategies.

Vitamin B12 in Fertility

Vitamin B12 is another critical nutrient that plays a vital role in fertility and pregnancy. A deficiency in vitamin B12 can lead to an increased risk of miscarriage, birth defects, and other complications. It is important to ensure adequate vitamin B12 intake, especially for those with genetic polymorphisms impacting folate metabolism.

Key Markers in Pathology Testing

Pathology testing can provide clues as to folate and vitamin B12 deficiency, including red blood cell folate and serum vitamin B12 levels. It is essential to monitor these markers regularly and adjust folate supplementation as needed.

Folate and Folate Dosing

For those with genetic polymorphisms impacting folate metabolism, folinic acid and methyl folate may be better options than folic acid. These active forms of folate can help ensure adequate folate intake and reduce the risk of miscarriage. The optimal dosing for folate supplementation may vary depending on individual needs, and healthcare practitioners should guide patients in developing a customized folate supplementation plan

Conclusion

Understanding the role of folate and genetic polymorphisms in fertility patients is crucial in reducing the risk of miscarriage. Healthcare practitioners should guide patients in identifying genetic polymorphisms impacting folate metabolism, monitoring key markers in pathology testing, and developing a customized folate supplementation plan. By taking a proactive approach to folate supplementation, we can improve the chances of a healthy pregnancy and reduce the emotional and financial toll of miscarriage.

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