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Extended folic acid use reduces the likelihood of SGA in mothers under 35 and primiparas but may elevate LGA risk if continued after the first trimester, particularly among multiparas and women with lower education.
An observational study, based on the Jinan birth cohort, has shed light on how folic acid (also known as vitamin B9) supplementation during pregnancy might influence a baby’s growth in the womb. As per the findings, more than 4 months of folic acid use can reduce small-for-gestational-age (SGA) risk in younger and first-time mothers, while extended supplementation after the first trimester may escalate large-for-gestational-age (LGA) risk in multiparas and less-educated women.
While folic acid is already well-known for preventing neural tube defects, its role in affecting fetal weight for gestational age has remained unclear—until now. Hence, multivariate logistic regression and stratified analyses were used to explore the association between folic acid use and the risk of abnormal fetal growth across different maternal subgroups. From an initial cohort of 6,640 mother–newborn pairs, 6,501 singleton live births qualified based on inclusion and exclusion criteria. Within this group, 73.0% of infants were born appropriate-for-gestational-age, while 5.2% were SGA, and 21.7% (1,413 out of 6,501) were LGA.
Interestingly, mothers who took folic acid supplements for over 4 months experienced a reduced likelihood of delivering an SGA baby—especially if they were under 35 years old (odds ratio [OR] = 0.76, 95% confidence interval [CI]: 0.58–0.99) or first-time mothers (OR = 0.73, 95% CI: 0.54–0.98). As for LGA outcomes, folic acid intake during pregnancy appeared to offer protection too—but notably among mothers with 13 or more years of education (OR = 0.69, 95% CI: 0.51–0.94). The findings suggest that the duration and timing of folic acid intake during pregnancy might need a more personalized approach.
While early supplementation remains crucial, these results hint that longer use may not be one-size-fits-all. Bottom line? Folic acid is essential—but how long you take it might matter more than we thought.
Clinical Nutrition ESPEN
Association between maternal folic acid supplementation in pregnancy and abnormal fetal growth: Evidence from a birth cohort baseline survey
Jiatao Zhang et al.
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