Folic acid supplements in pregnancy and early childhood respiratory health
- 1Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- 2Epidemiology Branch and Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- 3Department of General Practice and Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Siri E Håberg, Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, NO-0403 Oslo, Norway;
- Accepted 26 September 2008
- Published Online First 3 December 2008
Background: Folate supplementation is recommended for pregnant women to reduce the risk of congenital malformations. Maternal intake of folate supplements during pregnancy might also influence childhood immune phenotypes via epigenetic mechanisms.
Objective: To investigate the relationship between folate supplements in pregnancy and risk of lower respiratory tract infections and wheeze in children up to 18 months of age.
Methods: In the Norwegian Mother and Child Cohort Study, questionnaire data collected at several time points during pregnancy and after birth on 32 077 children born between 2000 and 2005 were used to assess the effects of folate supplements during pregnancy on respiratory outcomes up to 18 months of age, while accounting for other supplements in pregnancy and supplementation in infancy.
Results: Folate supplements in the first trimester were associated with increased risk of wheeze and respiratory tract infections up to 18 months of age. Adjusting for exposure later in pregnancy and in infancy, the relative risk for wheeze for children exposed to folic acid supplements in the first trimester was 1.06 (95% CI 1.03 to 1.10), the relative risk for lower respiratory tract infections was 1.09 (95% CI 1.02 to 1.15) and the relative risk for hospitalisations for lower respiratory tract infections was 1.24 (95% CI 1.09 to 1.41).
Conclusions: Folic acid supplements in pregnancy were associated with a slightly increased risk of wheeze and lower respiratory tract infections up to 18 months of age. The results suggest that methyl donors in the maternal diet during pregnancy may influence respiratory health in children consistent with epigenetic mechanisms.
▸ Additional details are published online only at http://adc.bmj.com/content/vol94/issue3
Funding: The study was supported by the Norwegian Association of Heart and Lung patients with EXTRA funds from the Norwegian Foundation for Health and Rehabilitation. The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health, NIH/NIEHS (grant no. N01-ES-85433), NIH/NINDS (grant no. 1 UO1 NS 047537-01) and the Norwegian Research Council/FUGE (grant no. 151918/S10). The funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Competing interests: None.
Ethics approval: The MoBa study has been approved by the Regional Committee for Ethics in Medical Research, the Norwegian Data Inspectorate and the Institution Review Board of the National Institute of Environment Health Sciences, USA.