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Maternal postpartum plasma folate status and preterm birth in a high-risk US population

  • Bolanle Olapeju (a1) (a2), Ahmed Saifuddin (a1), Guoying Wang (a1), Yuelong Ji (a1), Xiumei Hong (a1), Ramkripa Raghavan (a1), Amber Summers (a2), Amaris Keiser (a3), Hongkai Ji (a4), Barry Zuckerman (a5), Christina Yarrington (a6), Lingxin Hao (a7), Pamela J Surkan (a8), Tina L Cheng (a3) and Xiaobin Wang (a1) (a3)...

Abstract

Objective

While maternal folate deficiency has been linked to poor pregnancy outcomes such as neural tube defects, anaemia and low birth weight, the relationship between folate and preterm birth (PTB) in the context of the US post-folic acid fortification era is inconclusive. We sought to explore the relationship between maternal folate status and PTB and its subtypes, i.e. spontaneous and medically indicated PTB.

Design

Observational study.

Setting

Boston Birth Cohort, a predominantly urban, low-income, race/ethnic minority population at a high risk for PTB.

Participants

Mother–infant dyads (n 7675) enrolled in the Boston Birth Cohort. A sub-sample (n 2313) of these dyads had maternal plasma folate samples collected 24–72 h after delivery.

Results

Unadjusted and adjusted logistic regressions revealed an inverse relationship between the frequency of multivitamin supplement intake and PTB. Compared with less frequent use, multivitamin supplement intake 3–5 times/week (adjusted OR (aOR) = 0·78; 95 % CI 0·64, 0·96) or >5 times/week (aOR = 0·77; 95 % CI 0·64, 0·93) throughout pregnancy was associated with reduced risk of PTB. Consistently, higher plasma folate levels (highest v. lowest quartile) were associated with lower risk of PTB (aOR = 0·74; 95 % CI 0·56, 0·97). The above associations were similar among spontaneous and medically indicated PTB.

Conclusions

If confirmed by future studies, our findings raise the possibility that optimizing maternal folate levels across pregnancy may help to reduce the risk of PTB among the most vulnerable US population in the post-folic acid fortification era.

Copyright

Corresponding author

*Corresponding author: Email xwang82@jhu.edu

References

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