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    Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study.

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    Authors
    Bukowski, Radek
    Malone, Fergal D
    Porter, Flint T
    Nyberg, David A
    Comstock, Christine H
    Hankins, Gary D V
    Eddleman, Keith
    Gross, Susan J
    Dugoff, Lorraine
    Craigo, Sabrina D
    Timor-Tritsch, Ilan E
    Carr, Stephen R
    Wolfe, Honor M
    D'Alton, Mary E
    Show allShow less
    Affiliation
    Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States of America. rkbukows@utmb.edu
    Issue Date
    2009-05-05
    MeSH
    Adult
    Dietary Supplements
    Female
    Folic Acid
    Humans
    Infant, Newborn
    Maternal Nutritional Physiological Phenomena
    Preconception Care
    Pregnancy
    Premature Birth
    Risk Factors
    Vitamin B Complex
    Young Adult
    Show allShow less
    
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    Citation
    Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study. 2009, 6 (5):e1000061 PLoS Med.
    Journal
    PLoS medicine
    URI
    http://hdl.handle.net/10147/189827
    DOI
    10.1371/journal.pmed.1000061
    PubMed ID
    19434228
    Abstract
    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.
    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.
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1549-1676
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pmed.1000061
    Scopus Count
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