Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis

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Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates : a population study, systematic review and meta-analysis. / Hodgetts, V A; Morris, Katie; Francis, A; Gardosi, J; Ismail, K M.

In: BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 122, No. 4, 03.2015, p. 478-90.

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@article{bf006706c2164da591d511530666c8d2,
title = "Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis",
abstract = "OBJECTIVES: To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA).DESIGN: A population database study and a systematic review with meta-analysis including the results of this population study.SETTING AND DATA SOURCES: A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review.PARTICIPANTS AND INCLUDED STUDIES: Singleton live births with no known congenital anomalies; 111,736 in population study and 188,796 in systematic review.OUTCOME MEASURES, DATA EXTRACTION AND ANALYSIS: The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy-related characteristics.RESULTS: Of 108,525 pregnancies with information about FA supplementation, 92,133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39,416 pregnancies, of which FA was commenced before conception in 10,036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71-0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66-0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61-0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates.CONCLUSION: Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors.SYSTEMATIC REVIEW REGISTRATION: This systematic review was prospectively registered with PROSPERO number CRD42013004895.",
keywords = "Adult, Birth Weight, Dietary Supplements, Female, Fetal Development, Folic Acid, Great Britain, Health Knowledge, Attitudes, Practice, Humans, Infant, Newborn, Infant, Small for Gestational Age, Pregnancy, Pregnancy Outcome, Prenatal Nutritional Physiological Phenomena, Risk Factors",
author = "Hodgetts, {V A} and Katie Morris and A Francis and J Gardosi and Ismail, {K M}",
note = "{\textcopyright} 2014 Royal College of Obstetricians and Gynaecologists.",
year = "2015",
month = mar,
doi = "10.1111/1471-0528.13202",
language = "English",
volume = "122",
pages = "478--90",
journal = "BJOG: An International Journal of Obstetrics & Gynaecology",
issn = "1470-0328",
publisher = "Wiley",
number = "4",

}

RIS

TY - JOUR

T1 - Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates

T2 - a population study, systematic review and meta-analysis

AU - Hodgetts, V A

AU - Morris, Katie

AU - Francis, A

AU - Gardosi, J

AU - Ismail, K M

N1 - © 2014 Royal College of Obstetricians and Gynaecologists.

PY - 2015/3

Y1 - 2015/3

N2 - OBJECTIVES: To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA).DESIGN: A population database study and a systematic review with meta-analysis including the results of this population study.SETTING AND DATA SOURCES: A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review.PARTICIPANTS AND INCLUDED STUDIES: Singleton live births with no known congenital anomalies; 111,736 in population study and 188,796 in systematic review.OUTCOME MEASURES, DATA EXTRACTION AND ANALYSIS: The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy-related characteristics.RESULTS: Of 108,525 pregnancies with information about FA supplementation, 92,133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39,416 pregnancies, of which FA was commenced before conception in 10,036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71-0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66-0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61-0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates.CONCLUSION: Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors.SYSTEMATIC REVIEW REGISTRATION: This systematic review was prospectively registered with PROSPERO number CRD42013004895.

AB - OBJECTIVES: To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA).DESIGN: A population database study and a systematic review with meta-analysis including the results of this population study.SETTING AND DATA SOURCES: A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review.PARTICIPANTS AND INCLUDED STUDIES: Singleton live births with no known congenital anomalies; 111,736 in population study and 188,796 in systematic review.OUTCOME MEASURES, DATA EXTRACTION AND ANALYSIS: The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy-related characteristics.RESULTS: Of 108,525 pregnancies with information about FA supplementation, 92,133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39,416 pregnancies, of which FA was commenced before conception in 10,036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71-0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66-0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61-0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates.CONCLUSION: Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors.SYSTEMATIC REVIEW REGISTRATION: This systematic review was prospectively registered with PROSPERO number CRD42013004895.

KW - Adult

KW - Birth Weight

KW - Dietary Supplements

KW - Female

KW - Fetal Development

KW - Folic Acid

KW - Great Britain

KW - Health Knowledge, Attitudes, Practice

KW - Humans

KW - Infant, Newborn

KW - Infant, Small for Gestational Age

KW - Pregnancy

KW - Pregnancy Outcome

KW - Prenatal Nutritional Physiological Phenomena

KW - Risk Factors

U2 - 10.1111/1471-0528.13202

DO - 10.1111/1471-0528.13202

M3 - Article

C2 - 25424556

VL - 122

SP - 478

EP - 490

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

SN - 1470-0328

IS - 4

ER -