Despite adherence to routine prenatal care, a growing number of women continue to experience adverse pregnancy outcomes, and many children present with developmental challenges that cannot be explained by standard risk factors alone.
The traditional approach to prenatal care has long focused on well-established pillars: balanced nutrition, iron and folic acid supplementation, and regular antenatal checkups to support the health of both the expectant mother and her developing child. While this model has significantly improved maternal and neonatal outcomes, it has not fully addressed the rising incidence of certain pregnancyrelated complications, particularly neurodevelopmental disorders observed later in childhood.
Despite adherence to routine prenatal care, a growing number of women continue to experience adverse pregnancy outcomes, and many children present with developmental challenges that cannot be explained by standard risk factors alone. This gap has highlighted an important truth: conventional prenatal care often overlooks critical biological mechanisms that influence how nutrients are utilised, not just how much is consumed. As understanding of these biological gaps deepens, clinicians are increasingly turning to advanced diagnostics like Folate Receptor Autoantibody Testing (FRAT) to better understand what happens beyond routine supplementation.
Why Folate Matters?
Folate, a vital Bvitamin, plays a central role in the development of the fetal brain and spinal cord. Adequate maternal folate intake has been shown to reduce the risk of neural tube defects by up to 70%, making it one of the most important nutritional interventions during pregnancy.
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However, folate’s role in neurodevelopment depends not only on intake but also on effective transport and utilisation. For folate to support the developing brain, it must travel from the mother’s bloodstream to the fetus through specialised proteins known as folate receptors. In some women, the immune system produces autoantibodies that block these receptors, impairing folate transport, even when blood folate levels appear normal.
Understanding this mechanism is critical, as it explains why standard supplementation may not be sufficient for every pregnancy.
What Is FRAT Testing?
The Folate Receptor Autoantibody Test (FRAT) is a specialised blood test that detects antibodies that interfere with or block folate receptors. Unlike conventional antenatal tests that measure folate levels in the blood, FRAT evaluates whether folate can effectively cross biological barriers, particularly the bloodbrain barrier, to support optimal brain development.
By identifying these hidden biological barriers, FRAT enables clinicians to move beyond a “onesizefitsall” approach to supplementation and instead design personalised nutritional and therapeutic strategies based on individual biology.
FRAT and Child Neurodevelopment
The relevance of FRAT testing extends beyond pregnancy. It has also shown clinical value in children with neurodevelopmental conditions such as autism spectrum disorder (ASD), developmental delays, attentiondeficit/hyperactivity disorder (ADHD), and seizure disorders.
In India, it is estimated that approximately 1 in 100 children is on the autism spectrum, while global prevalence estimates range from 1 in 36 to 1 in 100. Although these conditions arise from a complex interplay of genetic and environmental factors, FRAT testing highlights a specific and actionable biological pathway related to impaired folate transport.
Importantly, this pathway is not only identifiable but also potentially modifiable, allowing clinicians to explore targeted interventions as part of a broader treatment strategy.
Who Should Consider FRAT Testing?
FRAT testing may be particularly relevant for:
Women planning to conceive, especially those seeking to optimise fetal brain development during critical growth windows
Women with a history of unexplained infertility or recurrent miscarriages
Pregnancies with prior complications, despite adherence to routine folate and nutritional supplementation
Mothers whose previous pregnancies were followed by unexplained developmental concerns in their children
Beyond prenatal care, FRAT testing may also be valuable for children with autism spectrum disorder, unexplained developmental delays, learning difficulties, or seizure disorders, where identifying immune-mediated or metabolic contributors can help guide more targeted clinical and nutritional interventions.
Towards Preventive and Personalised Healthcare
FRAT testing reflects a broader shift in healthcare, from reactive treatment to preventive and personalised care. By identifying biological risks early, clinicians can intervene proactively, often before complications or developmental delays become clinically apparent.
This approach aligns with the growing emphasis on precision medicine, where care is tailored not just to symptoms, but to the underlying biological mechanisms influencing health outcomes.
A Step Forward
This preventive and personalised approach is already being implemented in clinical settings. Screening among pregnant women revealed that nearly 50% tested positive for folate receptor autoantibodies, allowing for timely intervention during critical windows of fetal brain development.
In paediatric screening of over 600 children, approximately 75% tested FRAT positive. Early observations indicate that within three months of targeted intervention, nearly 60% of these children demonstrated noticeable improvements, particularly in areas such as verbal communication and attention span.
While further research and long-term follow-up are essential, these early insights highlight the potential impact of identifying and addressing folate transport challenges at the right time.
Conclusion
FRAT testing helps in reshaping clinical conversations around maternal and child health by highlighting the critical link between nutrition, immune function, and neurodevelopment. By shifting the focus from nutrient intake alone to nutrient utilisation, FRAT enables clinicians and families to make more informed decisions during pregnancy and early childhood.
As healthcare continues to move toward preventive, evidence-based, and personalised models of care, tools like FRAT have the potential to improve outcomes not only for individual families but also for future generations.
-By Aditi Ohri – Co-Founder, Mr. Yoda
