medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-453medsovet-9520Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNECOLOGYЭпигенетические аспекты применения фолатов в период преконцепцииEpigenetic aspects of preconceptional folate supplementationhttps://orcid.org/0000-0001-6589-7654ШихЕ. В.ShikhE. V.

Ших Евгения Валерьевна - д.м.н., профессор, заведующая кафедрой клинической фармакологии и пропедевтики внутренних болезней.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Evgenia V. Shikh - Dr. Sci. (Med.), Professor, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

shikh_e_v@staff.sechenov.ruhttps://orcid.org/0000-0001-9817-9886МаховаА. А.MakhovaA. A.

Махова Анна Александровна - д.м.н., доцент кафедры клинической фармакологии и пропедевтики внутренних болезней.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Anna A. Makhova, Dr. Sci. (Med.), Associate Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

makhova_a_a@staff.sechenov.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202520112025017104112Copyright © Ших Е.В., Махова А.А., 20252025Ших Е.В., Махова А.А.Shikh E.V., Makhova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9520

Фолаты (витамин B9) играют ключевую роль в одноуглеродном метаболизме, синтезе нуклеотидов и метилировании ДНК, что делает их критическими для эмбрионального и плацентарного развития. Недостаток фолатов ассоциирован с врожденными пороками, осложнениями беременности и психическими расстройствами, включая перинатальную депрессию. В ряде исследований продемонстрировано, что недостаточное поступление фолата с пищей может привести к нарушению этого пути и снижению уровня метилирования ДНК, которое является основным эпигенетическим фактором, влияющим на активность генов. Во время внутриутробного развития именно состояние метилирования играет важную роль в организации фундаментальных биологических процессов, таких как импринтинг, инактивация Х-хромосомы, дифференцировка, плюрипотентность. Цель работы – обобщить современные данные (2023–2025 гг.) о роли фолатов при беременности с акцентом на эпигенетические механизмы, концепцию Developmental Origins of Health and Disease (DOHaD), когнитивные исходы у потомства и возможности персонализированной нутритивной поддержки. В обзоре представлены экспериментальные и клинические данные о влиянии фолатов на эпигенетическую регуляцию, плацентарную функцию и долгосрочное здоровье потомства. Показано, что саплементация снижает риск дефектов нервной трубки, преэклампсии и задержки роста плода. Обсуждается связь фолатного статуса с когнитивным развитием детей и перинатальной депрессией у женщин. Особое внимание уделено биомаркерам мониторинга (фолат эритроцитов, гомоцистеин, В12) и генетическим предикторам (полиморфизмы MTHFR), определяющим необходимость персонализированного подхода. Адекватное обеспечение фолатами в периконцепционный период и во время беременности имеет решающее значение для профилактики акушерских и психических осложнений, а также для формирования долгосрочного здоровья потомства. Персонализированные стратегии саплементации, основанные на биомаркерах и генетических особенностях, представляют собой перспективное направление клинической практики.

Folates (vitamin B9) are essential for one-carbon metabolism, nucleotide synthesis, and DNA methylation, playing a central role in embryonic and placental development. Folate deficiency is associated with neural tube defects, pregnancy complications, and mental health disorders, including perinatal depression. Several studies have shown that inadequate dietary intake of folate may disrupt this pathway and reduce DNA methylation, a major epigenetic factor influencing gene activities. DNA methylation during fetal development plays a critical role in regulating fundamental biological processes such as imprinting, X-chromosome inactivation, differentiation, and pluripotency. Objective – to summarize recent evidence (2023–2025) on the role of folates during pregnancy, with a focus on epigenetic mechanisms, the Developmental Origins of Health and Disease (DOHaD) concept, offspring cognitive outcomes, and opportunities for personalized nutritional support. The review highlights experimental and clinical findings on the impact of folates on epigenetic regulation, placental function, and longterm offspring health. Supplementation is shown to reduce the risk of neural tube defects, preeclampsia, and intrauterine growth restriction. Associations between maternal folate status, child cognitive development, and perinatal depression are discussed. Special attention is given to monitoring biomarkers (red blood cell folate, homocysteine, vitamin B12) and genetic predictors (MTHFR polymorphisms) to justify a personalized approach. Adequate folate intake in the periconceptional period and throughout pregnancy is crucial for preventing obstetric and psychiatric complications and shaping favorable long-term offspring outcomes. Personalized supplementation strategies based on biomarkers and genetic data represent a promising avenue for clinical practice.

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The authors declare that there are no conflicts of interest present.