Initiation and duration of folic acid supplementation in preventing congenital malformations
Abstract
Background
Folic acid (FA) supplementation is associated with a lower risk of the neural tube and heart defects and is recommended for women of childbearing age. Although there are detailed recommendations, differences in the initiation time and duration of FA supplementation remain poorly studied.
Methods
A multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options.
Results
Periconceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44–1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21–1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08–5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33–0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36–0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations.
Conclusions
The timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention.
Trial registration
Chictr.org.cn identifier: ChiCTR-SOC-17010976.
Top-30
Journals
|
1
2
3
|
|
|
Nutrients
3 publications, 13.64%
|
|
|
International Journal of Molecular Sciences
2 publications, 9.09%
|
|
|
European Journal of Medical Research
2 publications, 9.09%
|
|
|
Heliyon
1 publication, 4.55%
|
|
|
Journal of Agricultural and Food Chemistry
1 publication, 4.55%
|
|
|
Frontiers in Neuroscience
1 publication, 4.55%
|
|
|
Clinical Nutrition
1 publication, 4.55%
|
|
|
Annals of Medicine and Surgery
1 publication, 4.55%
|
|
|
Handbook of Research on Trends in the Diagnosis and Treatment of Chronic Conditions
1 publication, 4.55%
|
|
|
Frontiers in Pediatrics
1 publication, 4.55%
|
|
|
International Journal of Biological Macromolecules
1 publication, 4.55%
|
|
|
Immunological Reviews
1 publication, 4.55%
|
|
|
International Journal of Environmental Research and Public Health
1 publication, 4.55%
|
|
|
Environmental Health: A Global Access Science Source
1 publication, 4.55%
|
|
|
PLoS ONE
1 publication, 4.55%
|
|
|
BMC Pregnancy and Childbirth
1 publication, 4.55%
|
|
|
Neurological Research and Practice
1 publication, 4.55%
|
|
|
Journal of Family Medicine and Primary Care
1 publication, 4.55%
|
|
|
1
2
3
|
Publishers
|
1
2
3
4
5
6
|
|
|
MDPI
6 publications, 27.27%
|
|
|
Springer Nature
5 publications, 22.73%
|
|
|
Elsevier
3 publications, 13.64%
|
|
|
Frontiers Media S.A.
2 publications, 9.09%
|
|
|
American Chemical Society (ACS)
1 publication, 4.55%
|
|
|
Ovid Technologies (Wolters Kluwer Health)
1 publication, 4.55%
|
|
|
IGI Global
1 publication, 4.55%
|
|
|
Wiley
1 publication, 4.55%
|
|
|
Public Library of Science (PLoS)
1 publication, 4.55%
|
|
|
Medknow
1 publication, 4.55%
|
|
|
1
2
3
4
5
6
|
- We do not take into account publications without a DOI.
- Statistics recalculated weekly.