Folic Acid Supplementation In Pregnancy Research Articles

Pregnancy, folic acid, and antiseizure medication

Abstract Background Although some antiseizure medications (ASMs) are teratogenic, most people with epilepsy need treatment in pregnancy. The risk of ASM fetotoxicity may be mitigated with folic acid. High-dose folic acid supplementation has traditionally been recommended before and during gestation despite little evidence of efficacy and safety for this patient group. Several studies have investigated the potential benefits and risks of folic acid supplements. Objective To provide an updated overview of the risks, benefits, and rationale for use of folic acid supplementation in relation to pregnant people of childbearing age using ASM. Materials and methods This is a narrative review based on an unstructured literature search of PubMed. We also scrutinized neurological and obstetrical guidelines. Results Antiseizure medication can decrease folate concentrations. In children exposed to ASM prenatally, those born to persons using folic acid supplements periconceptionally had lower risk of adverse neurodevelopment and preterm birth. It remains unclear whether the risk for congenital malformations can be equally alleviated. In studies of the general population, high plasma folate concentrations and/or high-dose folic acid supplements were associated with adverse neurodevelopmental outcomes. This has not been seen in children of mothers with epilepsy. However, an increased cancer risk has been found in children of mothers with epilepsy using high-dose folic acid supplements in pregnancy. Conclusion The optimal folic acid dose is not clear for persons of childbearing potential with epilepsy using ASM. Both low and excess folate status during pregnancy have been associated with adverse neurodevelopment. We propose an individual folic acid supplement dose that should be titrated based on maternal plasma folate concentrations during pregnancy.

Biological Role of Folic Acid in Pregnancy and Possible Therapeutic Application for the Prevention of Preeclampsia.

The rationale and importance of folic acid supplementation during pregnancy for fetal congenital defect prevention are accepted worldwide. Moreover, a sufficient plasma concentration of folates can reduce the incidence of spontaneous abortions, and support the normal expansion of placental blood vessels, ensuring physiological placental blood flow, thus promoting appropriate fetal growth and development. Furthermore, there is emerging evidence that long-term supplementation with folic acid can effectively prevent preeclampsia. Preeclampsia is unique to the human species in complications during pregnancy, which contributes to maternal and perinatal mortality worldwide. In the pathogenesis of preeclampsia abnormal placental invasion, the excess of antiangiogenic factors and maternal-placental syndrome play a key role. Increased blood levels of homocysteine during pregnancy are associated with the risk of preeclampsia. Moreover, hyperhomocysteinemia has been proposed to be an independent risk factor for preeclampsia. Folate supplementation helps to decrease elevated levels of homocysteine; thus, the role of folic acid supplementation in pregnancy is even more important. Multiple reports suggest that folate administration decreases the level of serum homocysteine and, therefore, reduce the risk and severity of preeclampsia. However, the association between folic acid supplementation and the decreased risk of preeclampsia has been investigated with controversial conclusions. Currently, the optimal dose of folic acid that is effective for preeclampsia prevention remains uncertain. In this review, we aim to summarize the accumulated knowledge on the role of folic acid in the pathogenesis of preeclampsia, and the possible impact of folate supplementation on the decreased risk of preeclampsia.

Factors Influencing Adherence to Iron and Folic Acid Supplementation among Pregnant Women attending Antenatal Care in Rubanda District, South Western-Uganda

Purpose: Globally, about 40% of pregnant women have anemia. Pregnant women are at high risk of iron and folic acid deficiency anemia due to increased nutrient requirement during pregnancy. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention of iron deficiency anemia in pregnant women. However, there remains poor adherence to iron and folic acid supplementation in pregnancy in many countries especially low-income countries. The aim of this study was to evaluate the level of adherence and the factors influencing adherence to iron and folic acid supplementation among pregnant women attending antenatal care in Rubanda District, south Western-Uganda.
 Methodology: A multi-Health facility based observational and descriptive cross-sectional study was done. One hundred seventy two (172) pregnant mothers attending antenatal clinic in six selected health facilities in Rubanda District were enrolled in this study from December 2021 to March 2022. The interviewer administered questionnaire was used to study the participant characteristics and logistic regression was used to identify the factors influencing adherence to iron and folic acid supplements.
 Findings: Majority of women were aged between 20-29 years (57.56%), married (94.77%) and unemployed (80.23%). More than half of the respondents (62.21%, 95% CI 54.89%-69.53%) had taken at least 80% of the prescribed iron and folic acid tablets. This reflected good adherence level. Factors independently influencing adherence included maternal age below 20 years (aOR 3.83, 95% CI 1.12-13.08, p-value 0.032), age between 20-29 years (aOR=4.86, 95%CI: 2.03-11.63, p value <0.001), adherence partner (aOR=2.82, 95%CI: 1.34-5.91, pvalue <0.001) and being counselled on importance of iron and folic acid tablets (aOR=4.42, 95%CI: 2.08-9.42, p-value <0.001).
 Recommendations: Intensive counselling during antenatal care about the importance of iron and folic acid supplements should be done on a daily basis with particular attention to women aged 30 years and above.

Maternal Knowledge on Recommended Iron and Folic Acid Supplementation in Pregnancy: A Hospital-based Cross-Sectional Study in Sri Lanka

Sri Lanka Journal of Medicine is the official journal of the Kandy Society of Medicine. It is a peer-reviewed journal currently published biannually. Original articles, reviews, brief reports, case reports, points of view, and letters to the editor, in all fields of medical science and practice are accepted for publication.The Sri Lanka Journal of Medicine is now indexed in DOAJ

A Review on Maternal Folic Acid and Supplementation

Folate (vitamin B9) is a necessary nutrient for DNA replication as well as a variety of enzymatic processes involved in amino acid synthesis and vitamin metabolism. Because folate is necessary for the fetus's growth and development, demand for it rises throughout pregnancy. Folate deficiency has been linked to birth defects in both mothers and babies (anaemia, peripheral neuropathy) (congenital abnormalities). The metabolism of folic acid, the appropriate use of folic acid supplementation in pregnancy, and the potential benefits of folic acid are discussed in this article, as well as the use of l-methyl folate supplementation for the prevention of pregnancy-related complications other than neural tube defects.

Iron and Folic Acid Supplementation in Pregnancy: Findings from the Baseline Assessment of a Maternal Nutrition Service Programme in Bangladesh.

Effective coverage of antenatal iron and folic acid (IFA) supplementation is important to prevent adverse maternal and newborn health outcomes. We interviewed 2572 women from two rural districts in Bangladesh who had a live birth in the preceding six months. We analysed the number of IFA tablets received and consumed during pregnancy and examined the factors influencing IFA consumption by multiple linear regression and user adherence-adjusted effective coverage of IFA (consuming ≥180 IFA tablets) by Poisson regression. Overall, about 80% of women consumed IFA supplements in any quantity. About 76% of women received antenatal care at least once, only 8% received ≥180 IFA tablets, and 6% had user adherence-adjusted coverage of antenatal IFA supplementation. Multivariable analysis showed a linear relationship between the number of antenatal care (ANC) visits and the number of IFA supplements consumed, which was modified by the timing of the first ANC visit. Women’s education, free IFA, and advice on IFA were also associated with higher IFA consumption. Interventions targeting at least eight ANC contacts, starting early in pregnancy, providing advice on the importance of IFA, and providing IFA supplements in higher quantity at ANC contacts are likely to increase effective coverage of antenatal IFA supplementation.

Folic acid usage and associated factors among pregnant women attending a tertiary health facility in Nigeria

Background: Folic acid (FA) is an essential water-soluble vitamin that cannot be synthesized in the human body; hence its major source is from diet. It plays a key role in embryonic development. FA supplementation in pregnancy reduces the risk of megaloblastic anaemia, preterm delivery and neural tube defects. The aim of the current study was to evaluate the use of FA and factors associated with uptake amongst pregnant women at the University of Port Harcourt Teaching Hospital.Methods: A descriptive cross-sectional study involving 451 antenatal attendees at the University of Port Harcourt Teaching Hospital from 1 January to 31 March 2020. After consent was obtained, a structured interviewer-administered questionnaire was used to collect information from the women. Data was entered into a spread sheet and analyzed with SPSS version 25. The results are presented in means and percentages. The confidence interval was set at 95% and a p value of <0.05 was deemed statistically significant. Chi square test and Pearson’s correlation were used to determine association between usage of FA and variables.Results: Most of the women, 258 (57.21%) were between the ages of 30 and 39 years and were primarily nulliparous 122 (27.1%). Moreover, two-thirds of them 330 (73.2%) had post-secondary education and nearly all 409 (90.7%) of the women were married. Majority 370 (82.0%) of the pregnant women were currently taking folic acid but only 109 (24.2%) commenced before pregnancy. Use of FA was significantly associated with socio-demographic characteristics such as age, marital status, level of education and occupation (p<0.05). In addition, parity, planned pregnancy, history of having a child with neural tube defect, and timing of commencement of folic acid were all significantly associated with folic acid usage (p<0.05).Conclusions: Only a small proportion of pregnant women have used FA before their pregnancies. A public health policy or strategy to increase the pre-conceptional use of folic acid is needed.

Impact of high-dose folic acid supplementation in pregnancy on biomarkers of folate status and 1-carbon metabolism: An ancillary study of the Folic Acid Clinical Trial (FACT)

Periconceptional folic acid (FA) supplementation is recommended to prevent the occurrence of neural tube defects. Currently, most over-the-counter FA supplements in Canada and the United States contain 1 mg FA and some women are prescribed 5 mg FA/d. High-dose FA is hypothesized to impair 1-carbon metabolism. We aimed to determine folate and 1-carbon metabolism biomarkers in pregnant women exposed to 1 mg or 5 mg FA. This was an ancillary study within the Folic Acid Clinical Trial (FACT), a randomized, double-blinded, placebo-controlled, phase III trial designed to assess the efficacy of high-dose FA to prevent preeclampsia. For FACT, women were randomized at 8-16 gestational weeks to receive daily 4.0 mg FA (high dose) or placebo (low dose) plus their usual supplementation (≤1.1 mg). Women were recruited from 3 Canadian FACT centers and provided nonfasting blood samples at 24-26 gestational weeks for measurement of RBC and serum total folate, serum unmetabolized FA (UMFA), tetrahydrofolate (THF), 5-methylTHF, 5-formylTHF, 5,10-methenylTHF, and MeFox (pyrazino-s-triazine derivative of 4α-hydroxy-5-methylTHF, a 5-methylTHF oxidation product); total vitamins B-12 and B-6; and plasma total homocysteine. Group differences were determined using χ2, Fisher exact, and Wilcoxon rank-sum tests. Nineteen (38%) women received high-dose FA and 31 (62%) received low-dose FA. The median RBC folate concentration was 2701 (IQR: 2243-3032) nmol/L and did not differ between groups. The high-dose group had higher serum total folate (median: 148.4 nmol/L, IQR: 110.4-181.2; P=0.007), UMFA (median: 4.6 nmol/L, IQR: 2.5-33.8; P=0.008), and 5-methylTHF (median: 126.6 nmol/L, IQR: 98.8-158.6; P=0.03) compared with the low-dose group (median: 122.8 nmol/L, IQR: 99.5-136.0; median: 1.9 nmol/L, IQR: 0.9-4.1; median: 108.6 nmol/L, IQR: 96.4-123.2, respectively). Other biomarkers of 1-carbon metabolism did not differ. High-dose FA supplementation in early pregnancy increases maternal serum folate but not RBC folate concentrations, suggesting tissue saturation. Higher UMFA concentrations in women receiving high-dose FA supplements suggest that these doses are supraphysiologic but with no evidence of altered 1-carbon metabolism.

Effects of maternal folic acid supplementation during the second and third trimesters of pregnancy on neurocognitive development in the child: an 11-year follow-up from a randomised controlled trial

BackgroundMaternal folic acid (FA) supplementation before and in early pregnancy prevents neural tube defects (NTD), but it is uncertain whether continuing FA after the first trimester has benefits on offspring health. We aimed to evaluate the effect of FA supplementation throughout pregnancy on cognitive performance and brain function in the child.MethodsFollow-up investigation of 11-year-old children, residing in Northern Ireland, whose mothers had participated in a randomised trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy and received 400 μg/day FA or placebo from the 14th gestational week. Cognitive performance (Full Scale Intelligence Quotient, Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed) was assessed using the Wechsler Intelligence Scale for Children. Neuronal function was assessed using magnetoencephalographic (MEG) brain imaging.ResultsOf 119 mother-child pairs in the FASSTT trial, 68 children were assessed for neurocognitive performance at 11-year follow-up (Dec 2017 to Nov 2018). Children of mothers randomised to FA compared with placebo scored significantly higher in two Processing Speed tests, i.e. symbol search (mean difference 2.9 points, 95% CI 0.3 to 5.5, p = 0.03) and cancellation (11.3 points, 2.5 to 20.1, p = 0.04), whereas the positive effect on Verbal Comprehension was significant in girls only (6.5 points, 1.2 to 11.8, p = 0.03). MEG assessment of neuronal responses to a language task showed increased power at the Beta (13–30 Hz, p = 0.01) and High Gamma (49–70 Hz, p = 0.04) bands in children from FA-supplemented mothers, suggesting more efficient semantic processing of language.ConclusionsContinued FA supplementation in pregnancy beyond the early period currently recommended to prevent NTD can benefit neurocognitive development of the child. MEG provides a non-invasive tool in paediatric research to objectively assess functional brain activity in response to nutrition and other interventions.Trial registrationISRCTN ISRCTN19917787. Registered on 15 May 2013.

Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy, Sri Lanka: A Hospital-Based Cross-Sectional Study.

Iron deficiency anaemia during pregnancy is a common public health problem that negatively affects maternal and newborn health. This study aims to identify the rate of maternal compliance with the recommended iron and folic acid (IFA) supplementation during pregnancy and to identify factors associated with maternal compliance and non-compliance. A hospital-based cross-sectional study was conducted among 703 women at 0–4 days postpartum. The prevalence of anaemia at the initial antenatal clinic (ANC) visit and at the third trimester were 20.8% and 44.9%, respectively. The rate of IFA supplementation compliance during pregnancy was 80.1%. Forgetfulness (66.9%) was the major reason for non-compliance, followed by side effects (15.7%). Maternal employment [OR (95%CI): 1.7 (1.00–2.89)], history of a low birth weight infant [OR (95%CI): 0.4 (0.19–0.9)] and history of anaemia [OR (95%CI): 0.4 (0.12–0.98] were significantly associated with maternal compliance with IFA supplementation. Only 26.6% of the participants adhered to dietary recommendations during the period when IFA supplements were provided. The rate of maternal compliance with IFA supplementation was high. However, the prevalence of maternal anaemia during pregnancy was also high, which was presumably due to poor dietary compliance despite high IFA supplementation compliance.

Prevalence and factors associated with compliance to iron and folic acid supplementation in pregnancy in Tamale Metropolis, Ghana

Supplementation with iron and folic acid (IFA) is recommended to prevent anaemia in pregnancy. However, the effectiveness of the supplementation in improving haemoglobin level depends on the degree of compliance. It is therefore necessary to periodically assess level of compliance with IFA supplementation. The aim of this study was to assess the prevalence and factors associated with compliance to IFA supplementation in pregnancy in Tamale Metropolis, Ghana. A health facility–based cross-sectional study was conducted among 403 pregnant women who accessed antenatal clinic (ANC) services in three health facilities in Tamale Metropolis, Ghana. Simple random sampling was used to select study health facilities and participants. Compliance to IFA was defined as use of IFA supplement in 4 of the last 7 days. Logistic regression analysis was used to identify the determinants of IFA supplementation compliance. The mean age of the study population was 26.7 (± 4.18) years. The prevalence of compliance to IFA supplementation was 58.8% (215/403) and the main reason the women gave for non-compliance was forgetting to take the supplements (40.9%). Following multivariate analysis, factors that were significantly associated with compliance were pregnancy trimester at interview, educational level, IFA knowledge, sex of household head and household wealth index. About 3 out of 5 women seeking ANC services in Tamale Metropolis are compliant with IFA supplementation with some of their socio-demographic and household characteristics predicting compliance. Efforts to increase compliance to IFA supplementation must focus on education on its benefits and improvement of socio-economic status of women.

A root cause analysis of sub-optimal uptake and compliance to iron and folic acid supplementation in pregnancy in 7 districts of Zambia

BackgroundIron and Folic Acid are two of the micronutrients recommended for pregnant women to support optimal maternal outcomes with regard to preventing anaemia and foetal birth defects. It is difficult to establish if women provided with iron and folic acid supplementation in Zambia benefit from it and how well it is implemented. The overall objective of this study was to determine the levels of uptake and compliance to iron and folic acid in pregnancy among women of child-bearing age in Zambia, with a focus on both supply and demand factors.MethodsA cross sectional, mixed method study was done. Data was collected in August and September 2015 from six of the 14 districts in which Scaling Up Nutrition interventions were being undertaken as well as Lusaka district. A household survey covering 402 males and females of child-bearing age, 27 key informant interviews amongst key stakeholders and 12 focus group discussions at community level were conducted.ResultsAntenatal clinic attendance was almost universal (98.7%); the majority of both men (92.1%) and women (97.4%) had heard messages about iron and folic acid supplementation; the majority (96.5%) of women reported having taken iron and folic acid tablets during their last pregnancy, with 61.3% starting in the second trimester, 27.2% during the first trimester, and 7.7% in their third trimester. Eighty-five per cent (80.5%) of the women reported that they had taken all the tablets they were given with about 13.4% not taking all the tablets received.ConclusionsRoot cause analysis, using both qualitative and quantitative findings, showed that the main challenges faced were long distances to health facilities and high transport costs; some women not being reached with supplementation messaging; lack of formalised and uniform training around delivery of antenatal messages across health care workers; women not attending antenatal monthly to replenish supplements; and forgetfulness to take the drugs daily. While male involvement may be a supportive factor, it sometimes hinders women from accessing antenatal services. Results showed that both uptake and compliance to iron and folic acid supplementation in pregnancy in Zambia were sub-optimal.

Maternal folic acid supplementation and infant birthweight in low- and middle-income countries: A systematic review.

The relationship between maternal folic acid supplementation in pregnancy and infant birthweight has not been well described in low‐ and middle‐income countries. We conducted a systematic review and meta‐analysis of the current evidence of the association between folic acid supplementation in pregnancy on three primary outcomes: the incidence of low birthweight, small for gestational age, and mean birthweight. Seventeen studies were identified, which satisfied the inclusion criteria, covering a total of 275,421 women from 13 cohort studies and four randomized controlled trials. For the primary outcome of mean birthweight (n = 9), the pooled mean difference between folic acid and control groups was 0.37 kg (95% confidence interval [CI]: 0.24 to 0.50), and this effect was larger in the randomized controlled trials (0.56, 95% CI: 0.15 to 0.97, n = 3). The pooled odds ratio was 0.59 for low birthweight (95% CI: 0.47 to 0.74, n = 10) among folic acid supplementation versus control. The pooled odds ratio for the association with small for gestational age was 0.63 (95% CI: 0.39 to 1.01, n = 5). Maternal folic acid supplementation in low‐ and middle‐income countries was associated with an increased mean birthweight of infants and decreases in the incidence of low birthweight and small for gestational age.

Effect of High-dose Folic Acid Supplementation in Pregnancy on Preeclampsia (FACT): Double-blind, Phase III, Randomized Controlled, International, Multicenter Trial

(BMJ. 2018;362:k3478) Preeclampsia is a leading cause of perinatal morbidity and mortality, and causes >35,000 maternal deaths worldwide each year. While studies of the association between folic acid supplementation and the incidence of preeclampsia have yielded inconsistent results, a potential protective effect has been shown. Worldwide, folic acid supplementation has been recommended during the preconception period through the first trimester for the prevention of neural tube defects. Preeclampsia, however, has 2 stages: 1 in the late first trimester and another in the third trimester. This study aims to evaluate the effect of daily high-dose (4.0 mg) folic acid supplementation beyond the first trimester on the risk of preeclampsia in women with identified risk factors.

Multivitamins, iron and folic acid supplementation in pregnancy

Folic acid (FA) encapsulation in protein matrices has been reported as a suitable method for preventing FA degradation upon storage or processing as well as to improve its bioavailability.The ability of β-lactoglobulin (β-lg) and type A gelatin (G) to bind FA and form nano/microparticles under conditions of concentration (up to 5% w/w) and pH (3–7) that could have a technological application has been studied. The degree of folic acid binding to the proteins depended on their pH-dependent ζ-potential, indicating the occurrence of ionic bonds. Regardless of FA concentration, the percentage of bound FA to β-lg or G was 100% at pH 3.At pH 3, the size of particles strongly increased by increasing the molar FA/protein ratio. Protein aggregation and further flocculation was observed at higher molar ratios. However, the size of particles could be modulated by high intensity ultrasound application.FA/protein particles formed at pH 3 were totally reversible by shifting back the pH to 7.This pH dependence is strongly favorable for the delivery of FA at the duodene (pH 7) and for the protection of FA at the pH prevailing in the stomach (pH 3).

Effect of High Dose Folic Acid Supplementation in Pregnancy on Pre-eclampsia (FACT): Double Blind, Phase III, Randomised Controlled, International, Multicentre Trial

(Abstracted from BMJ 2018;362:k3478) Preeclampsia is a serious medical condition, affecting approximately 3% to 5% of pregnancies, accounting for more than 35,000 maternal deaths annually worldwide and an important factor in maternal morbidity. Preeclampsia affects multiple organ systems and leads to an increased risk of other severe maternal and neonatal complications in pregnancy.

Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial

ObjectiveTo determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2),...

Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis

ObjectivesWe aimed to systematically assess the relationship between folic acid supplementation in pregnancy and risk of preeclampsia and gestational hypertension.MethodsThe relevant studies were included by retrieving the Embase, PubMed and Cochrane library databases. Data extraction was conducted by two investigators independently. The risk ratio (RR) and 95% confidence interval (CI) were used as effect indexes to evaluate the relationship between folic acid supplementation and risk of gestational hypertension or preeclampsia. A subgroup analysis was performed according to the supplementation patterns of folic acid. The homogeneity of the effect size was tested across the studies, and publication biases were examined.ResultsIn total, 13 cohort studies and 1 randomized controlled trial study was included, containing 160,562 and 149,320 women with and without folic acid supplementation during pregnancy. Pooled results showed that risk of gestational hypertension was not associated with the supplementation of folic acid. However, folic acid supplementation during pregnancy could significantly reduce the risk of preeclampsia. Moreover, the results of subgroup analysis showed that the decreased preeclampsia risk was associated with supplementation of multivitamins containing folic acid rather than folic acid alone.ConclusionsOur findings indicate that the supplementation of multivitamins containing folic acid during pregnancy could significantly lower preeclampsia risk.

Effects of maternal folic acid supplementation on airway remodeling and allergic airway disease development

Objective: Maternal folic acid supplementation has been recommended prior to and during the first trimester of pregnancy to reduce the risk of infant neural tube defects. However, an uncertain relationship between folic acid supplementation during pregnancy and development of childhood asthma exists. Recent data show a methyl donor-rich diet could increase the risk of developing allergic airway disease through DNA methylation and aberrant gene transcription. This study evaluated the effect of folic acid supplementation during pregnancy on airway remodeling and allergic airway disease vulnerability in a mouse asthma model.Methods: BALB/c mice were divided into four groups according to gestational folic acid supplementation and postnatal ovalbumin (OVA) exposure: Group 1 (whole pregnancy folic acid supplementation + OVA-exposed group), Group 2 (first gestational week folic acid supplementation + OVA-exposed group), Group 3 (no folic acid supplementation + OVA-exposed group), and Group 4 (control group). Offspring were sacrificed on day 45 for immunohistological and ultrastructural tests.Results: In OVA challenged groups, folic acid supplementation led to a thicker epithelial and subepithelial smooth muscle layer than in the unsupplemented group. Moreover, folic acid supplementation during whole pregnancy (Group 1) was associated with a thicker epithelial and subepithelial smooth muscle layer than folic acid supplementation during the first week of pregnancy (Group 2), suggesting a duration–response relationship. Electron microscopic imaging revealed that structural changes including the loss of epithelial integrity, thickening of basement membrane, and subepithelial fibrosis were more prominent in the folic acid supplementation groups.Conclusions: This study suggested that maternal folic acid supplementation during pregnancy affects airway remodeling and increases the allergic responses induced by ovalbumin challenge in offspring. In addition, the effect size increased as the duration and cumulative dose increased.

Folic Acid Supplementation throughout pregnancy: psychological developmental benefits for children.

To test the effect of folic acid supplements taken throughout pregnancy on children's psychosocial development. A randomised controlled trial of folic acid supplementation in pregnancy, with parental rating using the Resiliency Attitudes and Skills Profile (RASP), the Strengths and Difficulties Questionnaire (SDQ) and the Trait Emotional Intelligence Questionnaire Child Short Form (TEIQue-CSF). Children aged 6-7 whose mothers received folic acid throughout pregnancy (n = 22) were compared to those whose mothers only received it during the first trimester (n = 17). Children whose mothers received the full-term supplement scored significantly higher on emotional intelligence and resilience. Hierarchical multiple regression analysis identified folate level at 36th gestational week as an important predictor of emotional intelligence (EI) and resilience. Although conclusions must be drawn with caution, this research presents a number of potential implications, the main one being a proposed policy recommendation for women to take folic acid for the duration of pregnancy rather than stopping at the end of the first trimester. The second is the potential for future research to explore the possible psychological and social development benefits and in line with this to try and identify the explanatory mechanism involved.