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European Journal of Nutrition

, Volume 55, Issue 4, pp 1411–1422 | Cite as

Folic acid supplementation, dietary folate intake and risk of preterm birth in China

  • Xiaohui Liu
  • Ling Lv
  • Hanru Zhang
  • Nan Zhao
  • Jie Qiu
  • Xiaochun He
  • Min Zhou
  • Xiaoying Xu
  • Hongmei Cui
  • Sufen Liu
  • Catherine Lerro
  • Xiaojuan Lin
  • Chong Zhang
  • Honghong Zhang
  • Ruifeng Xu
  • Daling Zhu
  • Yun Dang
  • Xudong Han
  • Haiya Bai
  • Ya Chen
  • Zhongfeng Tang
  • Ru Lin
  • Tingting Yao
  • Jie Su
  • Wendi Wang
  • Yueyuan Wang
  • Bin Ma
  • Huang Huang
  • Jiaxin Liang
  • Weitao Qiu
  • Qing Liu
  • Yawei Zhang
Original Contribution

Abstract

Purpose

Folic acid supplementation has been suggested to reduce the risk of preterm birth. However, results from previous epidemiologic studies have been inconclusive. We investigated the hypothesis that folic acid supplementation and dietary folate intake during pre- and post-conception reduces the risk of preterm birth.

Methods

We analyzed data from a birth cohort study conducted between 2010 and 2012 in Lanzhou, China, including 10,179 pregnant women with live singleton births.

Results

Compared to non-users, folic acid supplement users with >12-week duration had a reduced risk of preterm birth (OR 0.67, 95 % CI 0.55–0.83) with a significant dose–response relationship (P for trend = 0.01). A similar pattern was observed for spontaneous preterm birth. Stronger associations were seen for ever use of folic acid supplement and very preterm birth (OR 0.50, 95 % CI 0.36–0.69) and spontaneous very preterm birth (OR 0.42, 95 % CI 0.29–0.63). Dietary folate intake during preconception and pregnancy were also associated with reduced risk of preterm birth (OR 0.68, 95 % CI 0.56–0.83, OR 0.57, 95 % CI 0.47–0.70 for the highest quartiles, respectively), particularly for spontaneous very preterm (OR 0.41, 95 % CI 0.24–0.72, OR 0.26, 95 % CI 0.15–0.47 for the highest quartiles, respectively). There were also decreased risks of preterm birth observed per 10-µg increase in dietary folate intake, and similar associations were found after stratification by folic acid supplementation status.

Conclusions

Our results suggest that folic acid supplementation and higher dietary folate intake during preconception and pregnancy reduces the risk of preterm birth, and the protective effect varies by preterm subtypes.

Keywords

Dietary folate Epidemiology Folic acid supplements Preterm birth 

Abbreviations

PB

Preterm birth

PPROM

Preterm premature rupture of membranes

OR

Odds ratio

CI

Confidence interval

BMI

Body mass index

Notes

Acknowledgments

Research supported by internal funding from the Gansu Provincial Maternity and Child Care Hospital, and by the National Institutes of Health Grants (K02HD70324 and R01ES019587).

Conflict of interest

None.

Supplementary material

394_2015_959_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Xiaohui Liu
    • 1
  • Ling Lv
    • 1
  • Hanru Zhang
    • 1
  • Nan Zhao
    • 2
  • Jie Qiu
    • 1
  • Xiaochun He
    • 1
  • Min Zhou
    • 1
  • Xiaoying Xu
    • 1
  • Hongmei Cui
    • 1
  • Sufen Liu
    • 1
  • Catherine Lerro
    • 2
  • Xiaojuan Lin
    • 1
  • Chong Zhang
    • 1
  • Honghong Zhang
    • 1
  • Ruifeng Xu
    • 1
  • Daling Zhu
    • 1
  • Yun Dang
    • 1
  • Xudong Han
    • 1
  • Haiya Bai
    • 1
  • Ya Chen
    • 1
  • Zhongfeng Tang
    • 1
  • Ru Lin
    • 1
  • Tingting Yao
    • 1
  • Jie Su
    • 1
  • Wendi Wang
    • 1
  • Yueyuan Wang
    • 1
  • Bin Ma
    • 1
  • Huang Huang
    • 2
  • Jiaxin Liang
    • 2
  • Weitao Qiu
    • 1
  • Qing Liu
    • 1
  • Yawei Zhang
    • 2
  1. 1.Gansu Provincial Maternity and Child Care HospitalLanzhouChina
  2. 2.Yale School of Public HealthNew HavenUSA

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