Periconceptional Folic Acid Supplementation and the Risk of Spontaneous Abortion among Women Who Prepared to Conceive: Impact of Supplementation Initiation Timing

It is unclear whether periconceptional folic acid (FA) supplementation decreases the risk of spontaneous abortion (SA). The impact of supplementation initiation timing has not been ascertained. This cohort study aimed to investigate the association between maternal periconceptional FA supplementation and risk of SA, with due consideration of the supplementation initiation timing. Through the National Free Pre-conception Health Examination Project (NFPHEP), we identified 65,643 pregnancies on FA supplementation in Chongqing, China between 2010 and 2015. After adjusting for covariates, maternal periconceptional FA supplementation was associated with a lower risk of SA (adjusted risk ratio [aRR]: 0.52; 95% confidence interval [CI]: 0.48–0.56). Pregnant women with FA supplementation initiated at least 3 months before conception had a 10% lower risk of SA (aRR: 0.46; 95% CI: 0.42–0.50) than those with FA supplementation initiated 1–2 months before conception (aRR: 0.56; 95% CI: 0.50–0.62) or after conception (aRR: 0.56; 95% CI: 0.51–0.61). These associations might not thoroughly account for FA supplementation, and to some extent our findings confirm the role of the utilization of healthcare in preventing SAs. Women who initiated healthcare, including taking FA earlier during the periconceptional period, could have a lower risk of SA.

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The impact of antenatal care, iron–folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh

PLoS ONE ◽

10.1371/journal.pone.0187090 ◽

2017 ◽

Vol 12 (11) ◽

pp. e0187090 ◽

Cited By ~ 4

Author(s):

Tanvir Abir ◽

Felix Akpojene Ogbo ◽

Garry John Stevens ◽

Andrew Nicolas Page ◽

Abul Hasnat Milton ◽

...

Keyword(s):

Folic Acid ◽

Antenatal Care ◽

Child Mortality ◽

Tetanus Toxoid ◽

Folic Acid Supplementation ◽

Acid Supplementation ◽

Iron Folic Acid Supplementation ◽

Iron Folic Acid ◽

The Impact

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Periconceptional use of cod liver oil, a vitamin D source, could decrease the risk of CHD in offspring

Cardiology in the Young ◽

10.1017/s1047951120002280 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1445-1451

Author(s):

Anda Zhao ◽

Kena Zhao ◽

Yuanqing Xia ◽

Yong Yin ◽

Jianzhen Zhu ◽

...

Keyword(s):

Vitamin D ◽

Folic Acid ◽

Propensity Score ◽

Propensity Score Matching ◽

Confidence Intervals ◽

Odds Ratio ◽

Folic Acid Supplementation ◽

Vitamin D Supplementation ◽

Cod Liver Oil ◽

Periconceptional Period

AbstractObjective:To explore if there is association between vitamin D supplementation through cod liver oil ingestion around the periconceptional period and the risk of developing severe CHD in offspring. Furthermore, we would examine the interaction between vitamin D and folic acid supplementation in the association.Methods:A case–control study was conducted in Shanghai Children’s Medical Center, in which, a total of 262 severe CHD cases versus 262 controls were recruited through June 2016 to December 2017. All children were younger than 2 years. To reduce potential selection bias and to minimise confounding effects, propensity score matching was applied.Results:After propensity score matching, vitamin D supplementation seemed to be associated with decreased odds ratio of severe CHD (odds ratio = 0.666; 95% confidence intervals: 0.449–0.990) in the multivariable conditional logistic analysis. Furthermore, we found an additive interaction between vitamin D and folic acid supplementation (relative excess risk due to interaction = 0.810, 95% confidence intervals: 0.386–1.235) in the association.Conclusion:The results suggested that maternal vitamin D supplementation could decrease the risk of offspring severe CHD; moreover, it could strengthen the protective effect of folic acid. The significance of this study lies in providing epidemiological evidence that vitamin D supplementation around the periconceptional period could be a potential nutritional intervention strategy to meet the challenge of increasing CHD.

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Maternal Folic Acid Intake and Risk of Nonsyndromic Orofacial Clefts: A Hospital-Based Case–Control Study in Bangalore, India

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619893214 ◽

2019 ◽

Vol 57 (6) ◽

pp. 678-686

Author(s):

Vivienne J. Mendonca

Keyword(s):

Folic Acid ◽

Case Control Study ◽

Folic Acid Supplementation ◽

Folic Acid Intake ◽

Orofacial Clefts ◽

Dietary Folate ◽

Acid Supplementation ◽

Folic Acid Supplements ◽

Periconceptional Period ◽

Control Study

Background: Orofacial clefts are the most common congenital anomaly worldwide. Cleft etiology appears to be multifactorial, with genetic and environmental components. Although periconceptional folic acid supplementation has been shown to be protective for neural tube defects, current evidence for its role in cleft prevention is mixed with few studies from low- and middle-income countries. Aim: To investigate the association between periconceptional folic acid intake and incidence of nonsyndromic orofacial clefts among infants in Bangalore, India. Methods: A hospital-based case–control study (106 cases, 212 controls) utilizing a questionnaire to collect data on prenatal supplements, dietary folate, and potentially confounding factors. Multivariate logistic regression analysis was used to assess relationships between folic acid supplementation and all nonsyndromic clefts, and in separate analyses for cleft lip and/or palate (CL/P) and cleft palate (CP), adjusting for statistically significant variables. Results: A statistically significant protective association was found for separate folic acid supplements (not combined with iron or multivitamins) taken in the periconceptional period and all clefts combined (adjusted odds ratio [OR]: 0.62, 95% confidence interval [CI], 0.45-0.86) and CL/P (adjusted OR: 0.57; 95% CI, 0.38-0.86). Higher levels of dietary folate were found to be associated with a reduced risk for all clefts (adjusted OR: 0.98, 95% CI, 0.96-0.99), CL/P (adjusted OR: 0.98, 95% CI, 0.96-0.99), and CP (adjusted OR: 0.96, 95% CI, 0.93-0.99). Conclusion: This study provides limited evidence for a protective association of periconceptional folic acid supplementation with nonsyndromic orofacial clefts. The low proportion of mothers taking folic acid supplements in the periconceptional period highlights the need for increased education and awareness regarding prenatal nutrition.

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Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort

Nutrients ◽

10.3390/nu11051108 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1108 ◽

Cited By ~ 4

Author(s):

Aurore Camier ◽

Manik Kadawathagedara ◽

Sandrine Lioret ◽

Corinne Bois ◽

Marie Cheminat ◽

...

Keyword(s):

Folic Acid ◽

Family Income ◽

Social Inequalities ◽

Multinomial Logistic Regression ◽

Unplanned Pregnancy ◽

Folic Acid Supplementation ◽

Sociodemographic Characteristics ◽

Acid Supplementation ◽

Periconceptional Period ◽

Maternal Overweight

Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l’Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.

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Outcome of Pregnancy Complicated by Threatened Abortion

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i1.6261 ◽

2012 ◽

Vol 9 (1) ◽

pp. 41-44 ◽

Cited By ~ 3

Author(s):

A Dongol ◽

S Mool ◽

P Tiwari

Keyword(s):

Folic Acid ◽

Spontaneous Abortion ◽

Growth Retardation ◽

Intrauterine Growth Retardation ◽

Bed Rest ◽

Folic Acid Supplementation ◽

Intrauterine Death ◽

Acid Supplementation ◽

Intrauterine Growth ◽

Threatened Abortion

Background Threatened abortion is the most common complication in the first half of pregnancy. Most of these pregnancies continue to term with or without treatment. Spontaneous abortion occurs in less than 30% of these women. Threatened abortion had been shown to be associated with increased incidence of antepartum haemorrhage, preterm labour and intra uterine growth retardation. Objective This study was to asses the outcome of threatened abortion following treatment. Methods This prospective study was carried out in Dhulikhel Hospital - Kathmandu University Hospital from January 2009 till May 2010. Total 70 cases of threatened abortion were selected, managed with complete bed rest till 48 hrs of cessation of bleeding, folic acid supplementation, uterine sedative, and hormonal treatment till 28 weeks of gestation. Ultrasonogram was performed for diagnosis and to detect the presence of subchorionic hematoma. Patients were followed up until spontaneous abortion or up to delivery of the fetus. The measures used for the analysis were maternal age, parity, gestational age at the time of presentation, previous abortions, presence of subchorionic hematoma, complete abortion, continuation of pregnancy, antepartum hemorrhage, intrauterine growth retardation and intrauterine death of fetus. Results Out of 70 cases subchorionic haematoma was found in 30 (42.9%) cases. There were 12 (17.1%) patients who spontaneously aborted after diagnosis of threatened abortion during hospital stay, 5 (7.1%) aborted on subsequent visits while 53 (75.8%) continued pregnancy till term. Among those who continued pregnancy intrauterine growth retardation was seen in 7 (13.2%), antepartum hemorrhage in 4 (7.5%), preterm premature rupture of membrane in 3 (5.66%) and IUD in 3 (5.66%). Spontaneous abortion was found more in cases with subchorionic hematoma of size more than 20 cm2. Conclusion In cases of threatened abortion with or without the presence of subchorionic hematoma, prognostic outcome is better following treatment with bed rest, uterine sedatives, folic acid supplementation and hormonal treatment.http://dx.doi.org/10.3126/kumj.v9i1.6261 Kathmandu Univ Med J 2011;9(1):41-4

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Oral Step-Down Therapy With Levofloxacin for Febrile Neutropenia in Children With Cancer

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa015 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jared Olson ◽

Sonia Mehra ◽

Adam L Hersh ◽

Emily A Thorell ◽

Gregory J Stoddard ◽

...

Keyword(s):

Febrile Neutropenia ◽

Antibiotic Use ◽

Children With Cancer ◽

Adjusted Risk ◽

Time Period ◽

Adjusted Risk Ratio ◽

Quasi Experimental ◽

Step Down ◽

Length Of Therapy ◽

The Impact

Abstract Background Although febrile neutropenia (FN) is a frequent complication in children with cancer receiving chemotherapy, there remains significant variability in selection of route (intravenous [IV] vs oral) and length of therapy. We implemented a guideline with a goal to change practice from using IV antibiotics after hospital discharge to the use of step-down oral therapy with levofloxacin for most children with FN until absolute neutrophil count > 500. The objectives of this study were to determine the impact of this guideline on home IV antibiotic use, and to evaluate the safety of implementation of this guideline. Methods We performed a quasi-experimental, pre–post study of discharge FN treatment at a stand-alone children’s hospital in patients without bacteremia discharged between January 2013 and October 2018. In January 2015, a multidisciplinary team created a guideline to switch most children with FN to oral levofloxacin, which was formally implemented as of September 2017. Discharges during the postintervention period (after September 2017) were compared to discharges in the preintervention period (between January 2013 and December 2014). Results In adjusted multivariable regression analyses, the postimplementation period was associated with a decrease in home IV antibiotics (adjusted risk ratio [aRR], 0.07 [95% confidence interval {CI}, .03–.13]) and fewer IV antibiotic initiations within 24 hours of a new healthcare encounter up to 7 days after discharge (aRR, 0.39 [95% CI, .17–.93]) compared to the preintervention time period. Conclusions Step-down oral levofloxacin for children with FN who are afebrile with an ANC ≤ 500 at discharge is feasible and resulted in similar clinical outcomes compared to home IV antibiotics.

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Stability of Orofacial Clefting Rate in Alberta, 1980–2011

The Cleft Palate-Craniofacial Journal ◽

10.1597/13-340 ◽

2014 ◽

Vol 51 (6) ◽

pp. 113-121 ◽

Cited By ~ 4

Author(s):

R. Brian Lowry ◽

Barbara Sibbald ◽

Tanya Bedard

Keyword(s):

Folic Acid ◽

Cleft Palate ◽

Congenital Anomalies ◽

Cleft Lip ◽

Folic Acid Supplementation ◽

Multiple Sources ◽

Orofacial Clefts ◽

Folic Acid Fortification ◽

Orofacial Clefting ◽

The Impact

Objective To determine the prevalence and trends of orofacial clefts in Alberta (Canada) over a 33-year period (1980 through 2011) and to determine whether the trends differ for subcategories of orofacial clefts for the period from 1997 through 2011. Design A prevalence study based on the Alberta Congenital Anomalies Surveillance System, which has multiple sources of ascertainment, capability of verification, and an upper age limit of 1 year. Inclusion All live born and stillborn babies and fetal deaths less than 20 weeks' gestation (including terminations of pregnancy) born in Alberta of mothers who reside in Alberta. Results and Conclusions Rates for cleft lip with or without cleft palate and cleft palate only have been very stable over the 33-year period (1980 through 2011). These rates include all clefts (isolated, syndromes, recognizable conditions, chromosomal and multiple congenital anomalies). Ascertainment of fetal deaths less than 20 weeks' gestation began in 1997. There are trends for the 1997 through 2011 cohort with a marginally significant increase for cleft lip with or without cleft palate in the isolated category and a significant decrease for cleft palate, mainly in the associated groups. The impact of folic acid fortification and/or multivitamins/folic acid supplementation reports in the literature have shown no consensus with respect to a change in the prevalence of orofacial clefts. It is unclear whether folic acid fortification has had any impact in Alberta.

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The impact of folate status and folic acid supplementation on the micronucleus frequency in human erythrocytes

Mutation Research/Genetic Toxicology and Environmental Mutagenesis ◽

10.1016/j.mrgentox.2005.10.009 ◽

2006 ◽

Vol 603 (1) ◽

pp. 33-40 ◽

Cited By ~ 19

Author(s):

Lilianne Abramsson-Zetterberg ◽

Louise J.K. Durling ◽

Fan Yang-Wallentin ◽

Elisabet Rytter ◽

Bengt Vessby

Keyword(s):

Folic Acid ◽

Folic Acid Supplementation ◽

Human Erythrocytes ◽

Acid Supplementation ◽

Folate Status ◽

Micronucleus Frequency ◽

The Impact

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Moderate Folic Acid Supplementation in Pregnant Mice Results in Behavioral Alterations in Offspring with Sex-Specific Changes in Methyl Metabolism

Nutrients ◽

10.3390/nu12061716 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1716

Author(s):

Marta Cosín-Tomás ◽

Yan Luan ◽

Daniel Leclerc ◽

Olga V. Malysheva ◽

Nidia Lauzon ◽

...

Keyword(s):

Folic Acid ◽

Motor Development ◽

Methylenetetrahydrofolate Reductase ◽

Negative Impact ◽

Folic Acid Supplementation ◽

Behavioral Alterations ◽

Folate Supplementation ◽

Pregnancy And Lactation ◽

Behavioural Tests ◽

The Impact

Fifteen to 20% of pregnant women may exceed the recommended intake of folic acid (FA) by more than four-fold. This excess could compromise neurocognitive and motor development in offspring. Here, we explored the impact of an FA-supplemented diet (5× FASD, containing five-fold higher FA than recommended) during pregnancy on brain function in murine offspring, and elucidated mechanistic changes. We placed female C57BL/6 mice for one month on control diets or 5× FASD before mating. Diets were maintained throughout pregnancy and lactation. Behavioural tests were conducted on 3-week-old pups. Pups and mothers were sacrificed at weaning. Brains and livers were collected to examine choline/methyl metabolites and immunoreactive methylenetetrahydrofolate reductase (MTHFR). 5× FASD led to hyperactivity-like behavior and memory impairment in 3-week-old pups of both sexes. Reduced MTHFR protein in the livers of FASD mothers and male pups resulted in choline/methyl metabolite disruptions in offspring liver (decreased betaine) and brain (decreased glycerophosphocholine and sphingomyelin in male pups, and decreased phosphatidylcholine in both sexes). These results indicate that moderate folate supplementation downregulates MTHFR and alters choline/methyl metabolism, contributing to neurobehavioral alterations. Our findings support the negative impact of high FA on brain development, and may lead to improved guidelines on optimal folate levels during pregnancy.

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The interaction effect between physical and cultural leisure activities on the subsequent decline of instrumental ADL: the Fujiwara-kyo study

Environmental Health and Preventive Medicine ◽

10.1186/s12199-019-0826-4 ◽

2019 ◽

Vol 24 (1) ◽

Cited By ~ 2

Author(s):

Masayo Komatsu ◽

Kenji Obayashi ◽

Kimiko Tomioka ◽

Masayuki Morikawa ◽

Noriko Jojima ◽

...

Keyword(s):

Risk Ratio ◽

Lower Risk ◽

Social Role ◽

Leisure Activities ◽

Functional Decline ◽

Leisure Activity ◽

Independent Effect ◽

Positive Interaction ◽

Adjusted Risk ◽

Adjusted Risk Ratio

Abstract Background Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown. Methods We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index). Results The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004). Conclusions We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.

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