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Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters.
Am J Clin Nutr. 2013 Jul; 98(1):92-8.AJ

Abstract

BACKGROUND

Supplementation with folic acid (FA) is recommended worldwide before and during early pregnancy because of its proven effect in preventing neural tube defects, but the role of FA after the 12th gestational week (GW) is much less clear.

OBJECTIVE

We investigated maternal folate and homocysteine responses and related effects in the newborn that resulted from continued FA supplementation after the first trimester of pregnancy.

DESIGN

Pregnant women, aged 18-35 y, who were attending an antenatal clinic in Northern Ireland with singleton uncomplicated pregnancies and reported taking FA supplements in the first trimester, were randomly assigned at the start of trimester 2 to receive 400 μg FA/d or a placebo capsule.

RESULTS

A total of 119 women (60 women in the placebo group; 59 women in the treatment group) completed the trial. From GWs 14-36, mean (±SD) serum folate decreased (from 45.7 ± 21.3 to 19.5 ± 16.5 nmol/L; P < 0.001) in unsupplemented women, whereas plasma homocysteine increased (6.6 ± 2.3 to 7.6 ± 2.3 μmol/L; P < 0.001). However, FA supplementation prevented these changes and resulted in a significant increase in red blood cell folate concentrations from 1203 ± 639 to 1746 ± 683 nmol/L (P < 0.001; GWs 14-36). Cord blood folate was significantly higher in the FA group than in the placebo group (red blood cell concentrations of 1993 ± 862 and 1418 ± 557 nmol/L, respectively; P = 0.001).

CONCLUSIONS

Continued supplementation with 400 μg FA/d in trimesters 2 and 3 of pregnancy can increase maternal and cord blood folate status and prevent the increase in homocysteine concentration that otherwise occurs in late pregnancy. Whether these effects have benefits for pregnancy outcomes or early childhood requires additional study.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

McNulty B
Northern Ireland Centre for Food & Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom.
McNulty H
No affiliation info available
Marshall B
No affiliation info available
Ward M
No affiliation info available
Molloy AM
No affiliation info available
Scott JM
No affiliation info available
Dornan J
No affiliation info available
Pentieva K
No affiliation info available

MeSH

AdolescentAdultDietary SupplementsDouble-Blind MethodErythrocytesFemaleFolic AcidHomocysteineHumansInfant, NewbornMaleNeural Tube DefectsNorthern IrelandPregnancyPregnancy Trimester, FirstPregnancy Trimester, SecondPregnancy Trimester, ThirdYoung Adult

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23719554

Citation

McNulty, Breige, et al. "Impact of Continuing Folic Acid After the First Trimester of Pregnancy: Findings of a Randomized Trial of Folic Acid Supplementation in the Second and Third Trimesters." The American Journal of Clinical Nutrition, vol. 98, no. 1, 2013, pp. 92-8.
McNulty B, McNulty H, Marshall B, et al. Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters. Am J Clin Nutr. 2013;98(1):92-8.
McNulty, B., McNulty, H., Marshall, B., Ward, M., Molloy, A. M., Scott, J. M., Dornan, J., & Pentieva, K. (2013). Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters. The American Journal of Clinical Nutrition, 98(1), 92-8. https://doi.org/10.3945/ajcn.112.057489
McNulty B, et al. Impact of Continuing Folic Acid After the First Trimester of Pregnancy: Findings of a Randomized Trial of Folic Acid Supplementation in the Second and Third Trimesters. Am J Clin Nutr. 2013;98(1):92-8. PubMed PMID: 23719554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters. AU - McNulty,Breige, AU - McNulty,Helene, AU - Marshall,Barry, AU - Ward,Mary, AU - Molloy,Anne M, AU - Scott,John M, AU - Dornan,James, AU - Pentieva,Kristina, Y1 - 2013/05/29/ PY - 2013/5/31/entrez PY - 2013/5/31/pubmed PY - 2013/8/27/medline SP - 92 EP - 8 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 98 IS - 1 N2 - BACKGROUND: Supplementation with folic acid (FA) is recommended worldwide before and during early pregnancy because of its proven effect in preventing neural tube defects, but the role of FA after the 12th gestational week (GW) is much less clear. OBJECTIVE: We investigated maternal folate and homocysteine responses and related effects in the newborn that resulted from continued FA supplementation after the first trimester of pregnancy. DESIGN: Pregnant women, aged 18-35 y, who were attending an antenatal clinic in Northern Ireland with singleton uncomplicated pregnancies and reported taking FA supplements in the first trimester, were randomly assigned at the start of trimester 2 to receive 400 μg FA/d or a placebo capsule. RESULTS: A total of 119 women (60 women in the placebo group; 59 women in the treatment group) completed the trial. From GWs 14-36, mean (±SD) serum folate decreased (from 45.7 ± 21.3 to 19.5 ± 16.5 nmol/L; P < 0.001) in unsupplemented women, whereas plasma homocysteine increased (6.6 ± 2.3 to 7.6 ± 2.3 μmol/L; P < 0.001). However, FA supplementation prevented these changes and resulted in a significant increase in red blood cell folate concentrations from 1203 ± 639 to 1746 ± 683 nmol/L (P < 0.001; GWs 14-36). Cord blood folate was significantly higher in the FA group than in the placebo group (red blood cell concentrations of 1993 ± 862 and 1418 ± 557 nmol/L, respectively; P = 0.001). CONCLUSIONS: Continued supplementation with 400 μg FA/d in trimesters 2 and 3 of pregnancy can increase maternal and cord blood folate status and prevent the increase in homocysteine concentration that otherwise occurs in late pregnancy. Whether these effects have benefits for pregnancy outcomes or early childhood requires additional study. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/23719554/Impact_of_continuing_folic_acid_after_the_first_trimester_of_pregnancy:_findings_of_a_randomized_trial_of_Folic_Acid_Supplementation_in_the_Second_and_Third_Trimesters_ DB - PRIME DP - Unbound Medicine ER -