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Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study.

Abstract

BACKGROUND

Health authorities in numerous countries recommend periconceptional folic acid supplementation to prevent neural tube defects. The objective of this study was to examine the association of dietary folate intake and folic acid supplementation during different periods of pregnancy with the risk of spontaneous preterm delivery (PTD).

METHODS

The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 66,014 women with singleton pregnancies resulting in live births in 2002-2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until pregnancy week 24. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4-5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,755).

RESULTS

The median total folate intake was 313 μg/d (interquartile range IQR 167-558) in the overall population and 530 μg/d (IQR 355-636) in the supplement users. Eighty-five percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while only 44% initiated folic acid supplementation before pregnancy. Cox regression analysis showed that the amount of dietary folate intake (hazard ratio HR 1.00; confidence interval 95% CI 0.61-1.65) and supplemental folate intake (HR 1.00; CI 1.00-1.00) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for spontaneous PTD (HR 1.18; CI 1.05-1.32) compared to no folic acid supplementation preconception. There was no significant association with PTD when supplementation was initiated within 8 weeks preconception (HR 0.99; CI 0.87-1.13). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables.

CONCLUSIONS

Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Preconceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of spontaneous PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.

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    Source

    BMC pregnancy and childbirth 14: 2014 Nov 02 pg 375

    MeSH

    Adult
    Diet
    Dietary Supplements
    Female
    Folic Acid
    Gestational Age
    Humans
    Norway
    Preconception Care
    Pregnancy
    Premature Birth
    Proportional Hazards Models
    Prospective Studies
    Risk Assessment
    Surveys and Questionnaires
    Time Factors
    Vitamin B Complex
    Young Adult

    Pub Type(s)

    Journal Article
    Observational Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25361626

    Citation

    Sengpiel, Verena, et al. "Folic Acid Supplementation, Dietary Folate Intake During Pregnancy and Risk for Spontaneous Preterm Delivery: a Prospective Observational Cohort Study." BMC Pregnancy and Childbirth, vol. 14, 2014, p. 375.
    Sengpiel V, Bacelis J, Myhre R, et al. Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14:375.
    Sengpiel, V., Bacelis, J., Myhre, R., Myking, S., Devold Pay, A. S., Haugen, M., ... Jacobsson, B. (2014). Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study. BMC Pregnancy and Childbirth, 14, p. 375. doi:10.1186/s12884-014-0375-1.
    Sengpiel V, et al. Folic Acid Supplementation, Dietary Folate Intake During Pregnancy and Risk for Spontaneous Preterm Delivery: a Prospective Observational Cohort Study. BMC Pregnancy Childbirth. 2014 Nov 2;14:375. PubMed PMID: 25361626.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study. AU - Sengpiel,Verena, AU - Bacelis,Jonas, AU - Myhre,Ronny, AU - Myking,Solveig, AU - Devold Pay,Aase Serine, AU - Haugen,Margaretha, AU - Brantsæter,Anne-Lise, AU - Meltzer,Helle Margrete, AU - Nilsen,Roy Miodini, AU - Magnus,Per, AU - Vollset,Stein Emil, AU - Nilsson,Staffan, AU - Jacobsson,Bo, Y1 - 2014/11/02/ PY - 2014/06/06/received PY - 2014/10/16/accepted PY - 2014/11/2/entrez PY - 2014/11/2/pubmed PY - 2015/9/12/medline SP - 375 EP - 375 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 14 N2 - BACKGROUND: Health authorities in numerous countries recommend periconceptional folic acid supplementation to prevent neural tube defects. The objective of this study was to examine the association of dietary folate intake and folic acid supplementation during different periods of pregnancy with the risk of spontaneous preterm delivery (PTD). METHODS: The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 66,014 women with singleton pregnancies resulting in live births in 2002-2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until pregnancy week 24. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4-5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,755). RESULTS: The median total folate intake was 313 μg/d (interquartile range IQR 167-558) in the overall population and 530 μg/d (IQR 355-636) in the supplement users. Eighty-five percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while only 44% initiated folic acid supplementation before pregnancy. Cox regression analysis showed that the amount of dietary folate intake (hazard ratio HR 1.00; confidence interval 95% CI 0.61-1.65) and supplemental folate intake (HR 1.00; CI 1.00-1.00) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for spontaneous PTD (HR 1.18; CI 1.05-1.32) compared to no folic acid supplementation preconception. There was no significant association with PTD when supplementation was initiated within 8 weeks preconception (HR 0.99; CI 0.87-1.13). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables. CONCLUSIONS: Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Preconceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of spontaneous PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/25361626/Folic_acid_supplementation_dietary_folate_intake_during_pregnancy_and_risk_for_spontaneous_preterm_delivery:_a_prospective_observational_cohort_study_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-014-0375-1 DB - PRIME DP - Unbound Medicine ER -