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Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia.
J Nutr. 2021 07 01; 151(7):1976-1982.JN

Abstract

BACKGROUND

Periconceptional folic acid (FA) supplementation is recommended to prevent neural tube defects; however, the extent to which recommendations are met through dietary sources and supplements is not clear.

OBJECTIVES

Our objective was to evaluate the dietary and supplemental intakes of FA in a Canadian pregnancy cohort and to determine the proportions of pregnant women exceeding the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL).

METHODS

FACT (the Folic Acid Clinical Trial) was an international multicenter, randomized, double-blinded, placebo-controlled, phase III trial investigating FA for the prevention of pre-eclampsia in high-risk pregnancies. Participants were enrolled from Canadian sites at 8-16 weeks of gestation. Dietary and supplemental FA intake data were collected through participant interviews and FFQs at the time of FACT enrollment. Categorical data were summarized as n (%) and continuous data as median (IQR).

RESULTS

This study included 1198 participants. Participants consumed 485 μg dietary folate equivalents (DFE)/d (IQR: 370-630 μg DFE/d) from dietary sources of folate and FA. Through diet alone, 43.4% of participants consumed ≥520 μg DFE/d, the EAR for pregnant individuals. Of the 91.9% of participants who consumed daily FA supplements, 0.4% consumed <400 μg FA/d and 96.0% consumed ≥1000 μg/d, the UL for FA. Median (IQR) total folate intake was 2167 μg DFE/d (2032-2325 μg DFE/d); 95.3% of participants met or exceeded the EAR from all sources, but 1069 (89.2%) participants exceeded the UL.

CONCLUSIONS

The majority of participants in this Canadian pregnancy cohort did not consume the recommended amount of folate from dietary sources. However, most prenatal supplements contained 1000 μg FA, resulting in the majority of women exceeding the UL. With no additional benefit associated with FA intakes beyond the UL for most women, modification of prenatal supplement formulations may be warranted to ensure women meet but do not exceed recommended FA intakes.FACT was registered at clinicaltrials.gov as NCT01355159 and at isrctn.com as ISRCTN23781770.

Links

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Authors+Show Affiliations

Rose EG
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Murphy MSQ
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Erwin E
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Muldoon KA
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Harvey ALJ
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Rennicks White R
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
MacFarlane AJ
Nutrition Research Division, Health Canada, Ottawa, Ontario, Canada. Department of Biology, Carleton University, Ottawa, Ontario, Canada.
Wen SW
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
Walker MC
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.

MeSH

CanadaDietary SupplementsFemaleFolic AcidHumansPre-EclampsiaPregnancyVitamins

Pub Type(s)

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

Language

eng

PubMed ID

33851221

Clinical Trial Links

Clinical trial which this article describes

Citation

Rose, Elaine G., et al. "Gestational Folate and Folic Acid Intake Among Women in Canada at Higher Risk of Pre-Eclampsia." The Journal of Nutrition, vol. 151, no. 7, 2021, pp. 1976-1982.
Rose EG, Murphy MSQ, Erwin E, et al. Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia. J Nutr. 2021;151(7):1976-1982.
Rose, E. G., Murphy, M. S. Q., Erwin, E., Muldoon, K. A., Harvey, A. L. J., Rennicks White, R., MacFarlane, A. J., Wen, S. W., & Walker, M. C. (2021). Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia. The Journal of Nutrition, 151(7), 1976-1982. https://doi.org/10.1093/jn/nxab063
Rose EG, et al. Gestational Folate and Folic Acid Intake Among Women in Canada at Higher Risk of Pre-Eclampsia. J Nutr. 2021 07 1;151(7):1976-1982. PubMed PMID: 33851221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia. AU - Rose,Elaine G, AU - Murphy,Malia S Q, AU - Erwin,Erica, AU - Muldoon,Katherine A, AU - Harvey,Alysha L J, AU - Rennicks White,Ruth, AU - MacFarlane,Amanda J, AU - Wen,Shi Wu, AU - Walker,Mark C, PY - 2020/11/12/received PY - 2020/12/16/revised PY - 2021/02/19/accepted PY - 2021/4/15/pubmed PY - 2022/1/29/medline PY - 2021/4/14/entrez KW - folate KW - folic acid KW - pregnancy KW - supplementation KW - vitamin B-9 SP - 1976 EP - 1982 JF - The Journal of nutrition JO - J Nutr VL - 151 IS - 7 N2 - BACKGROUND: Periconceptional folic acid (FA) supplementation is recommended to prevent neural tube defects; however, the extent to which recommendations are met through dietary sources and supplements is not clear. OBJECTIVES: Our objective was to evaluate the dietary and supplemental intakes of FA in a Canadian pregnancy cohort and to determine the proportions of pregnant women exceeding the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL). METHODS: FACT (the Folic Acid Clinical Trial) was an international multicenter, randomized, double-blinded, placebo-controlled, phase III trial investigating FA for the prevention of pre-eclampsia in high-risk pregnancies. Participants were enrolled from Canadian sites at 8-16 weeks of gestation. Dietary and supplemental FA intake data were collected through participant interviews and FFQs at the time of FACT enrollment. Categorical data were summarized as n (%) and continuous data as median (IQR). RESULTS: This study included 1198 participants. Participants consumed 485 μg dietary folate equivalents (DFE)/d (IQR: 370-630 μg DFE/d) from dietary sources of folate and FA. Through diet alone, 43.4% of participants consumed ≥520 μg DFE/d, the EAR for pregnant individuals. Of the 91.9% of participants who consumed daily FA supplements, 0.4% consumed <400 μg FA/d and 96.0% consumed ≥1000 μg/d, the UL for FA. Median (IQR) total folate intake was 2167 μg DFE/d (2032-2325 μg DFE/d); 95.3% of participants met or exceeded the EAR from all sources, but 1069 (89.2%) participants exceeded the UL. CONCLUSIONS: The majority of participants in this Canadian pregnancy cohort did not consume the recommended amount of folate from dietary sources. However, most prenatal supplements contained 1000 μg FA, resulting in the majority of women exceeding the UL. With no additional benefit associated with FA intakes beyond the UL for most women, modification of prenatal supplement formulations may be warranted to ensure women meet but do not exceed recommended FA intakes.FACT was registered at clinicaltrials.gov as NCT01355159 and at isrctn.com as ISRCTN23781770. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/33851221/Gestational_Folate_and_Folic_Acid_Intake_among_Women_in_Canada_at_Higher_Risk_of_Pre_Eclampsia_ DB - PRIME DP - Unbound Medicine ER -