Maternal smoking and lack of folic acid supplement use during the periconceptional period as risk factors for the VACTERL association using data of the AGORA data- and Biobank and the EUROCAT Northern Netherlands registry

Preconception folic acid supplement use is a well-known method of primary prevention of neural tube defects (NTDs). Obese women are at a higher risk for having a child with a NTD. As different international recommendations on folic acid supplement use for obese women before and during pregnancy exist, this narrative review provides an overview of epidemiology of folate deficiency in obese (pre)pregnant women, elaborates on potential mechanisms underlying folate deficiency, and discusses considerations for the usage of higher doses of folic acid supplements. Women with obesity more often suffer from an absolute folate deficiency, as they are less compliant to periconceptional folic acid supplement use recommendations. In addition, their dietary folate intake is limited due to an unbalanced diet (relative malnutrition). The association of obesity and NTDs also seems to be independent of folate intake, with studies suggesting an increased need of folate (relative deficiency) due to derangements involved in other pathways. The relative folate deficiency, as a result of an increased metabolic need for folate in obese women, can be due to: (1) low-grade chronic inflammation (2) insulin resistance, (3) inositol, and (4) dysbiotic gut microbiome, which plays a role in folate production and uptake. In all these pathways, the folate-dependent one-carbon metabolism is involved. In conclusion, scientific evidence of the involvement of several folate-related pathways implies to increase the recommended folic acid supplementation in obese women. However, the physiological uptake of synthetic folic acid is limited and side-effects of unmetabolized folic acid in mothers and offspring, in particular variations in epigenetic (re)programming with long-term health effects, cannot be excluded. Therefore, we emphasize on the urgent need for further research and preconception personalized counseling on folate status, lifestyle, and medical conditions.

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Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/84.5.1134 ◽

2006 ◽

Vol 84 (5) ◽

pp. 1134-1141 ◽

Cited By ~ 80

Author(s):

Roy M Nilsen ◽

Stein E Vollset ◽

Håkon K Gjessing ◽

Per Magnus ◽

Helle M Meltzer ◽

...

Keyword(s):

Cohort Study ◽

Folic Acid ◽

Pregnant Women ◽

Folic Acid Supplement ◽

Supplement Use ◽

Acid Supplement ◽

Mother And Child

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Preconceptional folic acid supplement use in Lebanon

Public Health Nutrition ◽

10.1017/s136898000800298x ◽

2009 ◽

Vol 12 (5) ◽

pp. 687-692 ◽

Cited By ~ 15

Author(s):

H Tamim ◽

G Harrison ◽

M Atoui ◽

G Mumtaz ◽

F El-Kak ◽

...

Keyword(s):

Folic Acid ◽

Economic Status ◽

National Level ◽

Folic Acid Supplementation ◽

Folic Acid Supplement ◽

Awareness Campaigns ◽

Supplement Use ◽

Acid Supplement ◽

Trained Personnel ◽

History Of

AbstractObjectiveThe objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon.Design/setting/subjectsThe study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003–January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use.ResultsThe overall use of preconceptional folic acid supplementation was 14·0 % (18·6 % in urban hospitals v. 2·7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use.ConclusionOur study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level.

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Race and ethnicity and preconception folic acid supplement use among pregnant women in Georgia, PRAMS 2009 to 2011

Birth Defects Research ◽

10.1002/bdra.23597 ◽

2017 ◽

Vol 109 (1) ◽

pp. 38-48 ◽

Cited By ~ 3

Author(s):

Ayesha Mukhtar ◽

Michael R. Kramer ◽

Godfrey P. Oakley ◽

Vijaya Kancherla

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Race And Ethnicity ◽

Folic Acid Supplement ◽

Supplement Use ◽

Acid Supplement

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Validation of self-reported folic acid use in a multiethnic population: results of the Amsterdam Born Children and their Development study

Public Health Nutrition ◽

10.1017/s1368980011000012 ◽

2011 ◽

Vol 14 (11) ◽

pp. 2022-2028 ◽

Cited By ~ 8

Author(s):

Jonne J Sikkens ◽

Manon van Eijsden ◽

Gouke J Bonsel ◽

Martina C Cornel

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Serum Folate ◽

Folic Acid Supplement ◽

Folic Acid Intake ◽

Development Study ◽

Supplement Use ◽

Acid Intake ◽

Acid Supplement ◽

Multiethnic Population

AbstractObjectiveTo assess folic acid supplementation rates and validate the self-reporting of folic acid supplement use among pregnant women in a multiethnic cohort.DesignSecondary analysis of a prospective cohort study.SettingSelf-reported folic acid supplement use in the Amsterdam Born Children and their Development study cohort was compared with serum folate concentrations using non-parametric trend analysis and linear and logistic regression.SubjectsA total of 4234 pregnant women of various ethnic backgrounds.ResultsSerum folate levels showed a significant positive linear trend as reported use of folic acid increased (P < 0·001), which was supported by linear regression (r = 0·49). Odds of having low serum folate concentration decreased with reported early start of folic acid intake. Young, multiparous or non-Western women reported less pre-conception folic acid intake. Non-Western women showed lower serum folate concentrations. The overall rate of over-reporting, i.e. serum folate concentrations ≤20 nmol/l while reporting the use of folic acid supplements, was 20·7 %. Women of Surinamese and Moroccan ancestry had higher odds of over-reporting (OR = 2·3; 95 % CI 1·5, 3·5 and OR = 2·3; 95 % CI 1·3, 4·0, respectively). The odds for Surinamese women remained significant after adjusting for the onset of supplement use, parity and age (OR = 1·7; 95 % CI 1·1, 2·6).ConclusionsAlthough self-reporting is a valid method for assessing folic acid supplement use in a multiethnic population, some participants do over-report. Surinamese and possibly Moroccan women appear to over-report more often. Rates of supplementation are low, especially in non-Western women. This suggests the need for intensifying current campaigns or perhaps even additional advice to start or continue to use folic acid post-conceptionally.

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Prevalence and correlates of high red blood cell folate concentrations in the Canadian population using 3 proposed cut-offs

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2015-0191 ◽

2015 ◽

Vol 40 (10) ◽

pp. 1025-1030 ◽

Cited By ~ 4

Author(s):

Cynthia K. Colapinto ◽

Deborah L. O’Connor ◽

Lise Dubois ◽

Mark S. Tremblay

Keyword(s):

Folic Acid ◽

Blood Cell ◽

Health Outcomes ◽

Red Blood Cell ◽

Folic Acid Supplement ◽

Cross Sectional ◽

Folate Status ◽

Supplement Use ◽

Acid Supplement ◽

Nationally Representative

A distinct shift towards higher folate concentrations has emerged in Canada. These higher concentrations have known benefits, including prevention of neural tube defects, but concerns have been raised regarding potential associations with adverse health outcomes. The aim of this research was to propose cut-offs for high red blood cell (RBC) folate concentrations and identify their correlates. RBC folate was measured in a nationally representative cross-sectional sample of Canadians (N = 5248) aged 6 to 79 years. RBC folate concentrations were adjusted from the IMMULITE 2000 immunoassay to a microbiologic assay. The population was characterized at 3 RBC folate cut-offs: 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L. We used t tests to examine differences by age, sex, income, and body mass index (BMI) at each cut-off and logistic regression to explore associations with folic acid supplement intake. The prevalence of high RBC folate was 16%, 6%, and 2% at thresholds of 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L, respectively. Females, those aged 60 to 79 years, and overweight or obese participants had the greatest prevalence of having high RBC folate at each cut-off. Folic acid supplement users were more likely than non-users to have high RBC folate concentrations. Older age, higher BMI, and folic acid supplement use were identified as correlates of high folate status. A high RBC folate concentration cut-off will advance the field towards consistent measurement and reporting of high folate status. This may facilitate future investigation of associations between RBC folate concentrations at the upper end of the distribution and health outcomes.

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Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the “Mamma & Bambino” Cohort

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020638 ◽

2020 ◽

Vol 17 (2) ◽

pp. 638 ◽

Cited By ~ 2

Author(s):

Martina Barchitta ◽

Andrea Maugeri ◽

Roberta Magnano San Lio ◽

Giuliana Favara ◽

Claudia La Mastra ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neonatal Outcomes ◽

Folate Intake ◽

Folic Acid Supplement ◽

Dietary Folate ◽

Supplement Use ◽

Acid Supplement ◽

Folic Acid Supplements ◽

Dietary Folate Intake

Folate requirement among women who plan to become pregnant should be raised to 600 μg/day during the periconceptional period. To meet this need, several countries began to promote the use of folic acid supplements before and during pregnancy. Here, we investigated prevalence and determinants of dietary folate intake and folic acid supplement use among 397 pregnant women (aged 15–50 years old, median = 37 years old). We also investigated their effects on neonatal outcomes in a subgroup of women who completed pregnancy. For doing that, we used data from the “Mamma & Bambino” project, an ongoing mother-child cohort settled in Catania (Italy). Inadequate folate intake was evaluated using a Food Frequency Questionnaire and defined as an intake < 600 μg/day. Women were also classified as non-users (i.e., women who did not use folic acid supplements), insufficient users (i.e., women who did not take folic acid supplements as recommended), and recommended users of folic acid supplements. Neonatal outcomes of interest were preterm birth (PTB) and small for gestational age (SGA). Nearly 65% of women (n = 257) reported inadequate folate intake, while 74.8% and 22.4% were respectively classified as insufficient or recommended users of supplements. We demonstrated higher odds of inadequate folate intake among smoking women (OR = 1.457; 95%CI = 1.046–2.030; p = 0.026), those who followed dietary restrictions (OR = 2.180; 95%CI = 1.085–4.378; p = 0.029), and those with low adherence to the Mediterranean Diet (OR = 3.194; 95%CI = 1.958–5.210; p < 0.001). In a subsample of 282 women who completed pregnancy, we also noted a higher percentage of SGA among those with inadequate folate intake (p < 0.001). Among 257 women with inadequate folate intake, those with low educational level were more likely to not take folic acid supplements than their more educated counterpart (OR = 5.574; 95%CI = 1.487–21.435; p = 0.012). In a subsample of 184 women with inadequate folate intake and complete pregnancy, we observed a higher proportion of SGA newborns among women who did not take supplement before pregnancy and those who did not take at all (p = 0.009). We also noted that the proportion of PTB was higher among non-users and insufficient users of folic acid supplements, but difference was not statistically significant. Our study underlined the need for improving the adherence of pregnant women with recommendations for dietary folate intake and supplement use. Although we proposed a protective effect of folic acid supplement use on risk of SGA, further research is encouraged to corroborate our findings and to investigate other factors involved.

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