Lactation

Unlike during pregnancy, in which the bulk of folate expenditure arises through catabolism, during lactation the increased requirement is chiefly due to milk secretion. Several observations indicate that mammary tissue takes precedence over other maternal tissues for folate resources. For instance, maternal folate status deteriorates in both early and late lactation, but milk folate concentration is maintained or increased. Moreover, supplemental folate appears to be taken up by mammary epithelial cells preferentially over hematopoietic cells in lactating women with folate deficiency, indicating that maternal reserves are depleted to maintain milk folate content in lactating women. Recommendations are based on the maintenance requirement of nonpregnant non-lactating women and the estimated folate intake required to replace the quantity lost in milk. This increment of between 60 mg and 100 mg daily is based on a milk secretion rate of 40-60 mgl 1 and an absorption rate from dietary sources of between 50% and 70%. The official recommendations might be underestimated, however. On the one hand, a less efficient absorption rate of 50% from a mixed diet is more likely, and, on the other hand, the most recent estimations of milk folate secretion are as high as 100 mg daily. Therefore, an additional 200 mg of folate daily or a total of 500 mg daily seems a more realistic recommended amount for lactating women.

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