Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Overview

Journal Med Princ Pract

Publisher Karger

Specialties General Medicine
Medical Education

Date 2024 Jul 29

PMID 39074445

Authors

Huang Wantong

Wenying Meng

Jie Zhang

Lei Jin

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP).

Subjects And Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age.

Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73-1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45-0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49-0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58-0.98).

Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

References

Fogacci S, Fogacci F, Cicero A . Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence. Nutrients. 2020; 12(2). PMC: 7071166. DOI: 10.3390/nu12020378. View

Pare E, Parry S, McElrath T, Pucci D, Newton A, Lim K . Clinical risk factors for preeclampsia in the 21st century. Obstet Gynecol. 2014; 124(4):763-770. DOI: 10.1097/AOG.0000000000000451. View

Li Z, Ye R, Zhang L, Li H, Liu J, Ren A . Folic acid supplementation during early pregnancy and the risk of gestational hypertension and preeclampsia. Hypertension. 2013; 61(4):873-9. DOI: 10.1161/HYPERTENSIONAHA.111.00230. View

Serrano N, Quintero-Lesmes D, Becerra-Bayona S, Guio E, Beltran M, Paez M . Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study. PLoS One. 2018; 13(12):e0208137. PMC: 6283543. DOI: 10.1371/journal.pone.0208137. View

Wu P, Haththotuwa R, Kwok C, Babu A, Kotronias R, Rushton C . Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2017; 10(2). DOI: 10.1161/CIRCOUTCOMES.116.003497. View

Li Q, Xu S, Chen X, Zhang X, Li X, Lin L . Folic Acid Supplement Use and Increased Risk of Gestational Hypertension. Hypertension. 2020; 76(1):150-156. DOI: 10.1161/HYPERTENSIONAHA.119.14621. View

Liu Y, Li N, An H, Li Z, Zhang L, Li H . Impact of gestational hypertension and preeclampsia on low birthweight and small-for-gestational-age infants in China: A large prospective cohort study. J Clin Hypertens (Greenwich). 2021; 23(4):835-842. PMC: 8678768. DOI: 10.1111/jch.14176. View

Poston L, Briley A, Seed P, Kelly F, Shennan A . Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): randomised placebo-controlled trial. Lancet. 2006; 367(9517):1145-54. DOI: 10.1016/S0140-6736(06)68433-X. View

Shen M, Smith G, Rodger M, White R, Walker M, Wen S . Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia. PLoS One. 2017; 12(4):e0175914. PMC: 5402970. DOI: 10.1371/journal.pone.0175914. View

10.

Norsworthy B, Skeaff C, Adank C, Green T . Effects of once-a-week or daily folic acid supplementation on red blood cell folate concentrations in women. Eur J Clin Nutr. 2004; 58(3):548-54. DOI: 10.1038/sj.ejcn.1601843. View

11.

Ramsay J, Ferrell W, Crawford L, Michael Wallace A, Greer I, Sattar N . Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002; 87(9):4231-7. DOI: 10.1210/jc.2002-020311. View

12.

Behere R, Deshmukh A, Otiv S, Gupte M, Yajnik C . Maternal Vitamin B12 Status During Pregnancy and Its Association With Outcomes of Pregnancy and Health of the Offspring: A Systematic Review and Implications for Policy in India. Front Endocrinol (Lausanne). 2021; 12:619176. PMC: 8074968. DOI: 10.3389/fendo.2021.619176. View

13.

Hofmeyr G, Lawrie T, Atallah A, Torloni M . Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018; 10:CD001059. PMC: 6517256. DOI: 10.1002/14651858.CD001059.pub5. View

14.

. [Diagnosis and treatment guideline of hypertensive disorders in pregnancy (2015)]. Zhonghua Fu Chan Ke Za Zhi. 2015; 50(10):721-8. View

15.

Zhang X, Liu J, Jin Y, Yang S, Song Z, Jin L . Folate of pregnant women after a nationwide folic acid supplementation in China. Matern Child Nutr. 2019; 15(4):e12828. PMC: 6859985. DOI: 10.1111/mcn.12828. View

16.

Wen S, Guo Y, Rodger M, White R, Yang Q, Smith G . Folic Acid Supplementation in Pregnancy and the Risk of Pre-Eclampsia-A Cohort Study. PLoS One. 2016; 11(2):e0149818. PMC: 4764298. DOI: 10.1371/journal.pone.0149818. View

17.

Kahveci B, Melekoglu R, Evruke I, Cetin C . The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy Childbirth. 2018; 18(1):343. PMC: 6106883. DOI: 10.1186/s12884-018-1984-x. View

18.

Wen S, White R, Rybak N, Gaudet L, Robson S, Hague W . Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. BMJ. 2018; 362:k3478. PMC: 6133042. DOI: 10.1136/bmj.k3478. View

19.

Ye C, Ruan Y, Zou L, Li G, Li C, Chen Y . The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One. 2014; 9(6):e100180. PMC: 4061123. DOI: 10.1371/journal.pone.0100180. View

20.

Bramswig S, Prinz-Langenohl R, Lamers Y, Tobolski O, Wintergerst E, Berthold H . Supplementation with a multivitamin containing 800 microg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res. 2010; 79(2):61-70. DOI: 10.1024/0300-9831.79.2.61. View