Document Detail


Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study.
MedLine Citation:
PMID:  19434228     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth.
METHODS AND FINDINGS: In a cohort of 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester of pregnancy. Duration of pregnancy was estimated based on first trimester ultrasound examination. Natural length of pregnancy was defined as gestational age at delivery in pregnancies with no medical or obstetrical complications that may have constituted an indication for delivery. Spontaneous preterm birth was defined as duration of pregnancy between 20 and 37 wk without those complications. The association between preconceptional folate supplementation and the risk of spontaneous preterm birth was evaluated using survival analysis. Comparing to no supplementation, preconceptional folate supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk (41 [0.27%] versus 4 [0.04%] spontaneous preterm births, respectively; HR 0.22, 95% confidence interval [CI] 0.08-0.61, p = 0.004) and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk (58 [0.38%] versus 12 [0.18%] preterm birth, respectively; HR 0.45, 95% CI 0.24-0.83, p = 0.010). Adjustment for maternal characteristics age, race, body mass index, education, marital status, smoking, parity, and history of prior preterm birth did not have a material effect on the association between folate supplementation for 1 y or longer and spontaneous preterm birth between 20 and 28, and 28 to 32 wk (adjusted HR 0.31, 95% CI 0.11-0.90, p = 0.031 and 0.53, 0.28-0.99, p = 0.046, respectively). Preconceptional folate supplementation was not significantly associated with the risk of spontaneous preterm birth beyond 32 wk. The association between shorter duration (<1 y) of preconceptional folate supplementation and the risk of spontaneous preterm birth was not significant after adjustment for maternal characteristics. However, the risk of spontaneous preterm birth decreased with the duration of preconceptional folate supplementation (test for trend of survivor functions, p = 0.01) and was the lowest in women who used folate supplementation for 1 y or longer. There was also no significant association with other complications of pregnancy studied after adjustment for maternal characteristics.
CONCLUSIONS: Preconceptional folate supplementation is associated with a 50%-70% reduction in the incidence of early spontaneous preterm birth. The risk of early spontaneous preterm birth is inversely proportional to the duration of preconceptional folate supplementation. Preconceptional folate supplementation was specifically related to early spontaneous preterm birth and not associated with other complications of pregnancy.
Authors:
Radek Bukowski; Fergal D Malone; Flint T Porter; David A Nyberg; Christine H Comstock; Gary D V Hankins; Keith Eddleman; Susan J Gross; Lorraine Dugoff; Sabrina D Craigo; Ilan E Timor-Tritsch; Stephen R Carr; Honor M Wolfe; Mary E D'Alton
Related Documents :
17206978 - Emerging tocolytics for maintenance therapy of preterm labour: oxytocin antagonists and...
12881078 - Risk factors for preterm delivery in south western nigeria.
6717868 - Predictability of pregnancy outcome in preterm delivery.
22410958 - Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy.
10088988 - Outcomes of children of extremely low birthweight and gestational age in the 1990's.
9445088 - Social motivation in recently weaned rats is modified by opiates.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-05-12
Journal Detail:
Title:  PLoS medicine     Volume:  6     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-12     Completed Date:  2009-06-30     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1000061     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States of America. rkbukows@utmb.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Dietary Supplements*
Female
Folic Acid / therapeutic use*
Humans
Infant, Newborn
Maternal Nutritional Physiological Phenomena*
Preconception Care*
Pregnancy
Premature Birth / prevention & control*
Risk Factors
Vitamin B Complex / therapeutic use*
Young Adult
Grant Support
ID/Acronym/Agency:
R01 HD38625/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
12001-76-2/Vitamin B Complex; 59-30-3/Folic Acid
Comments/Corrections
Comment In:
PLoS Med. 2009 May 5;6(5):e1000077   [PMID:  19434229 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  The vasorelaxant effect of Viscum album leaf extract is mediated by calcium-dependent mechanism.
Next Document:  The protective effects of ultraviolet A1 irradiation on spontaneous lupus erythematosus-like skin le...