Association Between Maternal Prepregnancy Body Mass Index and Plasma Folate Concentrations With Child Metabolic Health

Abstract

IMPORTANCE Previous reports have linked maternal prepregnancy obesity with low folate concentrations and child overweight or obesity (OWO) in separate studies. To our knowledge, the role of maternal folate concentrations, alone or in combination with maternal OWO, in child metabolic health has not been examined in a prospective birth cohort.OBJECTIVE To test the hypotheses that maternal folate concentrations can significantly affect child metabolic health and that sufficient maternal folate concentrations can mitigate prepregnancy obesity-induced child metabolic risk. DESIGN, SETTING, AND PARTICIPANTSThis prospective birth cohort study was conducted at the Boston Medical Center, Boston, Massachusetts. It included 1517 mother-child dyads recruited at birth from 1998 to 2012 and followed up prospectively up to 9 years from 2003 to 2014. MAIN OUTCOMES AND MEASURESChild body mass index z score calculated according to US reference data, OWO defined as a body mass index in the 85th percentile or greater for age and sex, and metabolic biomarkers (leptin, insulin, and adiponectin). RESULTSThe mean (SD) age was 28.6 (6.5) years for mothers and 6.2 (2.4) years for the children. An L-shaped association between maternal folate concentrations and child OWO was observed: the risk for OWO was higher among those in the lowest quartile (Q1) as compared with those in Q2 through Q4, with an odds ratio of 1.45 (95% CI, 1.13-1.87). The highest risk for child OWO was found among children of obese mothers with low folate concentrations (odds ratio, 3.05; 95% CI, 1.91-4.86) compared with children of normal-weight mothers with folate concentrations in Q2 through Q4 after accounting for multiple covariables. Among children of obese mothers, their risk for OWO was associated with a 43% reduction (odds ratio, 0.57; 95% CI, 0.34-0.95) if their mothers had folate concentrations in Q2 through Q4 compared with Q1. Similar patterns were observed for child metabolic biomarkers. CONCLUSIONS AND RELEVANCEIn this urban low-income prospective birth cohort, we demonstrated an L-shaped association between maternal plasma folate concentrations and child OWO and the benefit of sufficient folate concentrations, especially among obese mothers. The threshold concentration identified in this study exceeded the clinical definition of folate deficiency, which was primarily based on the hematological effect of folate. Our findings underscore the need to establish optimal rather than minimal folate concentrations for preventing adverse metabolic outcomes in the offspring.

Maternal Multivitamin Intake, Plasma Folate and Vitamin B12Levels and Autism Spectrum Disorder Risk in Offspring

“…The study included mother–infant pairs who were recruited at the Boston Medical Center (BMC) at the time of birth from 1998 to 2013 and followed up prospectively from 2003 to 2015 (Figure ), as described elsewhere . Children who were not intending to receive paediatric care at the BMC were excluded.…”

“…A recent NHANES study showed that unmetabolized folic acid (either from folic acid supplementation or fortified grain products) has been detected in most of the U.S. population . Furthermore, data from the Boston Birth Cohort showed a wide range of individual variation in plasma folate levels ranging from insufficient to excessive levels . The association between folic acid intake during pregnancy and ASD risk in offspring has been equivocal.…”

Joint Effect of Maternal Plasma Homocysteine and Prepregnancy Obesity on Child Blood Pressure: A Prospective Birth Cohort Study

“…11 In addition, maternal cardiometabolic risk factors (obesity, hypertensive-disorder, diabetes), poor birth outcome and maternal nutrition in the 3 rd trimester are associated with cardiovascular health in childhood. 32 Although we did not measure fetal Hcy concentrations, a previous study has suggested that the maternal Hcy level is the primary predictor of blood Hcy in the developing fetus. 46 In our study, we based maternal prepregnancy BMI on selfreported height and weight, thus it may have been subject to reporting bias that led to a misclassification for overweight and obesity.…”

Reduction of body weight, body fat mass, and serum leptin levels by addition of new beverage in normal diet of obese subjects

“…While, results of one study showed that, the squat serum folate level interconnected with obesity might be a result of less folate consumption or volumetric dilution of blood in obese subjects. Additionally, adiposity can effect on uptake of folate via intestinal epithelium (Wang et al, ). So, enhanced level of serum folate played an important role in the management of obesity.…”