Folic acid supplementation, dietary folate intake and risk of preterm birth in China

Liu, Xiaohui; Lv, Ling; Zhang, Hanru; Zhao, Nan; Qiu, Jie; He, Xiaoxuan; Zhou, Min; Xu, Xiaoying; Cui, Hongmei; Liu, Sufen; Lerro, Catherine C.; Lin, Xiaojuan; Zhang, Chong; Zhang, Honghong; Xu, Ruifeng; Zhu, Dan; Dang, Yun; Han, Xudong; Bai, Halbert; Ya, Chen; Tang, Zhongfeng; Lin, Ru; Yao, Tingting; Su, Jie; Wang, Wendi; Wang, Yueyuan; Ma, Ben; Huang, Huang; Liang, Jiaxin; Qiu, Weitao; Liu, Qing; Zhang, Yawei

doi:10.1007/s00394-015-0959-1

Cited by 29 publications

(30 citation statements)

References 49 publications

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“…Twelve studies [ 13 – 15 , 21 – 24 , 26 , 27 , 29 – 31 ] were included to explore the relationship between folic acid supplementation and preeclampsia risk. The heterogeneity was also high across these studies ( I 2 = 86%, P < 0.01), and the pool results showed that the decreased risk of preeclampsia is related to folic acid supplementation during pregnancy (RR = 0.69, 95% CI 0.58–0.83, P < 0.01, Fig.…”

Section: Resultsmentioning

confidence: 99%

Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis

Liu

Wang

Zhang

2018

Arch Gynecol Obstet

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ObjectivesWe aimed to systematically assess the relationship between folic acid supplementation in pregnancy and risk of preeclampsia and gestational hypertension.MethodsThe relevant studies were included by retrieving the Embase, PubMed and Cochrane library databases. Data extraction was conducted by two investigators independently. The risk ratio (RR) and 95% confidence interval (CI) were used as effect indexes to evaluate the relationship between folic acid supplementation and risk of gestational hypertension or preeclampsia. A subgroup analysis was performed according to the supplementation patterns of folic acid. The homogeneity of the effect size was tested across the studies, and publication biases were examined.ResultsIn total, 13 cohort studies and 1 randomized controlled trial study was included, containing 160,562 and 149,320 women with and without folic acid supplementation during pregnancy. Pooled results showed that risk of gestational hypertension was not associated with the supplementation of folic acid. However, folic acid supplementation during pregnancy could significantly reduce the risk of preeclampsia. Moreover, the results of subgroup analysis showed that the decreased preeclampsia risk was associated with supplementation of multivitamins containing folic acid rather than folic acid alone.ConclusionsOur findings indicate that the supplementation of multivitamins containing folic acid during pregnancy could significantly lower preeclampsia risk.Electronic supplementary materialThe online version of this article (10.1007/s00404-018-4823-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis

Liu

Wang

Zhang

2018

Arch Gynecol Obstet

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“…The process of data collection on folic acid supplementation and dietary folate intake has been described previously [ 31 , 32 ]. Briefly, four time periods information about folic acid supplements and dietary folate intake were collected: before conception (12 months before pregnancy), first trimester (1–13 weeks), second trimester (14–27 weeks) and third trimester (>27 weeks).…”

Section: Methodsmentioning

confidence: 99%

Maternal folic acid supplementation and dietary folate intake and congenital heart defects

et al. 2017

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BackgroundIt has been reported that folic acid supplementation before and/or during pregnancy could reduce the risk of congenital heart defects (CHDs). However, the results from limited epidemiologic studies have been inconclusive. We investigated the associations between maternal folic acid supplementation, dietary folate intake, and the risk of CHDs.MethodsA birth cohort study was conducted in 2010–2012 at the Gansu Provincial Maternity & Child Care Hospital in Lanzhou, China. After exclusion of stillbirths and multiple births, a total of 94 births were identified with congenital heart defects, and 9,993 births without any birth defects. Unconditional logistic regression was used to estimate the associations.ResultsCompared to non-users, folic acid supplement users before pregnancy had a reduced risk of overall CHDs (OR: 0.42, 95% CI: 0.21–0.86, Ptrend = 0.025) after adjusted for potential confounders. A protective effect was observed for certain subtypes of CHDs (OR: 0.37, 95% CI: 0.16–0.85 for malformation of great arteries; 0.26, 0.10–0.68 for malformation of cardiac septa; 0.34, 0.13–0.93 for Atrial septal defect). A similar protective effect was also seen for multiple CHDs (OR: 0.49, 95% CI: 0.26–0.93, Ptrend = 0.004). Compared with the middle quartiles of dietary folate intake, lower dietary folate intake (<149.88 μg/day) during pregnancy were associated with increased risk of overall CHDs (OR: 1.63, 95% CI: 1.01–2.62) and patent ductus arteriosus (OR: 1.85, 95% CI: 1.03–3.32). Women who were non-user folic acid supplement and lower dietary folate intake have almost 2-fold increased CHDs risk in their offspring.ConclusionsOur study suggested that folic acid supplementation before pregnancy was associated with a reduced risk of CHDs, lower dietary folate intake during pregnancy was associated with increased risk. The observed associations varied by CHD subtypes. A synergistic effect of dietary folate intake and folic acid supplementation was also observed.

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“…In light of the importance of folate in preventing neural tube defects, women of childbearing age worldwide are recommended to take folic acid supplements from 3 months before conception to the first trimester (2) . In the past two decades, it has been reported that folic acid supplementation during the periconceptional period may protect pregnant women against the risk of a wide spectrum of adverse outcomes, such as pre-eclampsia (30) , preterm delivery (31) , fetal growth restriction (6)(7)(8)(9) and congenital heart defects (32) . However, except for neural tube defects, the potential preventative effect of folate in relation to adverse pregnancy outcomes such as SGA remains controversial.…”

Section: Discussionmentioning

confidence: 99%

The association of maternal dietary folate intake and folic acid supplementation with small-for-gestational-age births: a cross-sectional study in Northwest China

Liu

Zhang

et al. 2019

Br J Nutr

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The effect of maternal folate intake on small-for-gestational-age (SGA) births remains inconclusive. The present study aimed to investigate the associations of maternal folate intake from diet and supplements with the risk of SGA births using data from a cross-sectional study in Shaanxi Province of Northwest China. A total of 7307 women who were within 12 months (median 3; 10th–90th percentile 0–7) after delivery were included. Two-level models were adopted to examine the associations of folate (dietary folate, supplemental folic acid and total folate) intake with the risk of SGA births and birth weight Z score, controlling for a minimum set of confounders that were identified in a directed acyclic graph. Results showed that a higher supplemental folic acid intake during the first trimester was negatively associated with the risk of SGA births (≤60 d v. non-use: OR 0·80; 95 % CI 0·66, 0·96; >60 d v. non-use: OR 0·78; 95 % CI 0·65, 0·94; Ptrend = 0·010; per 10-d increase: OR 0·97; 95 % CI 0·95, 0·99). A higher total folate intake during pregnancy was associated with a reduced risk of SGA births (highest tertile v. lowest tertile: OR 0·77; 95 % CI 0·64, 0·94; Ptrend = 0·010; per one-unit increase in the log-transformed value: OR 0·81; 95 % CI 0·69, 0·95). A similar pattern was observed for the birth weight Z score. Our study suggested that folic acid supplementation during the first trimester and a higher total folate intake during pregnancy were associated with a reduced risk of SGA births.

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Folic acid supplementation, dietary folate intake and risk of preterm birth in China

Abstract: Our results suggest that folic acid supplementation and higher dietary folate intake during preconception and pregnancy reduces the risk of preterm birth, and the protective effect varies by preterm subtypes.

Cited by 29 publications

References 49 publications

Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis

Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis

Maternal folic acid supplementation and dietary folate intake and congenital heart defects

The association of maternal dietary folate intake and folic acid supplementation with small-for-gestational-age births: a cross-sectional study in Northwest China

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