Initiation and duration of folic acid supplementation in preventing congenital malformations.
Cohort study
Congenital malformation
Folic acid supplementation
Heart defects
Neural tube defects
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
07 08 2023
07 08 2023
Historique:
received:
15
02
2023
accepted:
24
07
2023
medline:
8
8
2023
pubmed:
7
8
2023
entrez:
6
8
2023
Statut:
epublish
Résumé
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. 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. 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. 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. Chictr.org.cn identifier: ChiCTR-SOC-17010976.
Sections du résumé
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.
Identifiants
pubmed: 37545008
doi: 10.1186/s12916-023-03000-8
pii: 10.1186/s12916-023-03000-8
pmc: PMC10405478
doi:
Substances chimiques
Folic Acid
935E97BOY8
Vitamin B Complex
12001-76-2
Banques de données
ChiCTR
['ChiCTR-SOC-17010976']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
292Investigateurs
Gui-Hua Wu
(GH)
Liu-Ying Zhou
(LY)
Mei Li
(M)
Yue-Qin Chen
(YQ)
Jia-Xiang Yang
(JX)
Bai-Song Liang
(BS)
Tong Ru
(T)
Chun-Li Jing
(CL)
Weng-Rong Zhou
(WR)
Li Cao
(L)
Qin Li
(Q)
Gui-Ping Li
(GP)
Tai-Zhu Yang
(TZ)
Xin-Ru Gao
(XR)
Li-Ling Shi
(LL)
Yu-Qing Zhou
(YQ)
Xue-Qin Ji
(XQ)
Bo Liang
(B)
Qing Han
(Q)
Ling Ren
(L)
Wen-Rong Wang
(WR)
Guo-Wei Tao
(GW)
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
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