Folate Before Conception Lowers Small-for-Gestational-Age Risk Laurie Barclay, MD November 26, 2014 Preconceptual folic acid supplementation significantly reduces the risk for small for gestational age (SGA) at birth, according to a population database study and systematic review published online November 26 in BJOG. It is currently a standard recommendation in the [National Institute for Health and Care Excellence] antenatal care guidelines for women to take folic acid supplements before conception and for the first 12 weeks of pregnancy and the [Royal College of Obstetricians and Gynaecologists (RCOG)] supports this, recommending folic acid to women, RCOG Vice President of Clinical Quality Professor Alan Cameron, MD, said in an RCOG news release. There is a good scientific evidence base to suggest folic acid reduces the number of pregnancies affected by neural tube defects...such as spina bifida. This study provides further evidence of the positive health benefits of folic acid with regards to reducing the number of SGA babies born in the UK, he continued. V.A. Hodgetts, from the Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, United Kingdom, and colleagues used a UK regional database for the population study and an electronic literature search through August 2013 for the systematic review. The researchers aimed to determine the effect of folic acid supplementation timing during pregnancy on the risk for SGA in the neonate. The population study included 111,736 singleton live births without known congenital anomalies, and the systematic review included 188,796 such births. Among 108,525 pregnancies with information about folic acid in the population study, 84.9% of mothers had taken folic acid during pregnancy, but only 25.5% began folic acid before conception. Overall, 13.4% of babies had a birth weight under the 10th centile and 7% under the 5th centile. For pregnancies in which mothers took no folate, these percentages were 16.3% and 8.9%, respectively. After adjusting for maternal and pregnancy-related characteristics, women who started folic acid supplementation before conception had a 20% lower risk for SGA lower than the 10th centile (adjusted odds ratio [aOR], 0.80; 95% confidence interval [CI], 0.71 - 0.90; P < .01) and 22% lower risk for SGA lower than the 5th centile (aOR, 0.78; 95% CI, 0.66 - 0.91; P < .01) compared with those who did not. Pooling these data with data from other studies in the systematic review yielded a similar result: Women who started folic acid supplementation before conception had a 25% lower risk for SGA lower than the 5th centile (aOR, 0.75; 95% CI, 0.61 - 0.92; P < .006). Beginning folate during pregnancy did not significantly affect SGA rates. Study limitations include the inability to determine a dose-response relationship between folic acid supplementation and SGA. Previous research has suggested that only around one-third of women take folic acid supplements pre-conceptually, Dr. Cameron said. Therefore, strategies to increase uptake must be evaluated as some women may not plan their pregnancy. He concluded, The RCOG supports a food fortification policy with mandatory fortification of bread or flour with folic acid as a public health measure to improve the lives of both mothers and babies, [which] will reach women most at risk due to poor dietary habits or socioeconomic status. The authors have disclosed no relevant financial relationships. BJOG. Published online November 26, 2014.
Posted on: Thu, 04 Dec 2014 08:50:04 +0000
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