Periconception folic acid is linked to reduced NTD, miscarriage risk

  • Pei L & al.
  • Hum Reprod
  • 15.07.2019

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Folic acid supplementation is associated with lower risk for neural tube defects (NTDs) and miscarriage.

Why this matters

  • NTDs have been associated with low folic acid and first-trimester fever.
  • These authors conclude that spontaneous abortion may result from severe NTDs and that maternal folic acid supplementation may reduce NTD risk associated with spontaneous abortion.

Key results

  • The risk for NTDs was increased with a history of (aORs; 95% CIs): 
    • Spontaneous abortion: 2.59 (1.07-6.27);
    • Maternal first-trimester fever: 2.88 (1.16-7.14); and
    • No folic acid supplementation: 8.26 (3.09-22.06).
  • Interactions between no folic acid and a history of spontaneous abortion (aOR, 18.68; 95% CI, 4.43-78.76) further increased risks for NTD.
  • Other interactions were not statistically significant.

Study design

  • Population-based case-control study.
  • Cohorts obtained from the primary health care surveillance system and population-based birth defect surveillance system in China.
  • Families with NTD history (n=104) compared with families without NTD history (n=100) between 1993 and 2002.
  • Funding: National Natural Science Foundation of China and Danone Nutrition Center for Dietary Nutrition Research and Education Foundation. 

Limitations

  • Data on dietary folate intake, dose of folic acid supplementation, and maternal plasma folate concentration not collected.