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| Folic Acid May Prevent Preterm |
| By Laura Beil
Medscape Medical News
January 31, 2008 (Dallas) — Folic acid supplementation for 1 year before conception might significantly reduce the risk for preterm delivery, according to a new analysis involving more than 38,000 women.The finding, described here during the Society for Maternal-Fetal Medicine 28th Annual Meeting, suggests an easy and inexpensive method that may reduce the risk for preterm delivery. The effects were most profound with regard to the earliest preterm births, which was reduced by 70% among women who had taken folic acid for a year."This is exciting and promising," Radek Bukowski, MD, PhD, from the University of Texas Medical Branch at Galveston, told Medscape Ob/Gyn & Women's Health. However, he and others cautioned that the results need to be replicated and further scrutinized.Performing an observational cohort study, Dr. Bukowski and colleagues analyzed data from women who had participated in the First And Second Trimester Evaluation of Risk (FASTER) trial, sponsored by the National Institutes of Health. That earlier study had enrolled women with singleton pregnancies and was designed to improve early detection of Down syndrome. When entering the study, women reported on their use of folic acid before conception.About 20% of the participants, or 6777 women, had taken folic acid supplements for least 1 year before becoming pregnant, 36% had taken folic acid for less than 1 year, and 44% had not taken folic acid supplements at all. The study took into account age, race, body mass index, history of preterm birth, and other variables known to affect risk for early delivery. Across all groups, 160 preterm births occurred.During his presentation, Dr. Bukowski reported that the risk for earliest preterm deliveries — those happening between 20 and 28 weeks of pregnancy — was 70% lower among women with 1 year of folic acid use compared with those who had not taken the supplement. Rates of delivery between 28 and 32 weeks of pregnancy were 50% lower. Delivery rates after 32 weeks were similar in both groups. The trend had a P value of .01.The findings are tantalizing because folic acid is a simple intervention with a good safety record, and "[i]t could be very easily implemented," Dr. Bukowski said. Although the study did not ask the amount taken, the assumption, he noted, is that the women took the currently recommended 400-μg daily dose.These results fit with observational studies that have found an association between serum folic acid levels and risk for preterm delivery. The mechanism to explain folic acid's protection, however, remains unclear. Dr. Bukowski hypothesized that folic acid might boost the immune system, which may protect pregnant women against infection. He said he does not believe that longtime use of folic acid is simply a marker for better health habits, as his analysis tried to account for these influences.To further explore these and other questions, Dr. Bukowski is next evaluating serum samples of the study participants, looking for correlations with the concentration of folic acid and other micronutrients.Meanwhile, there are still too few data to make universal recommendations, said Brian Mercer, MD, director of maternal-fetal medicine at MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, and program chair for the meeting. "We need to see the final results when the study is published," he said. However, if the results hold up, folic acid may be "one of the very few opportunities to prevent first preterm births."The FASTER trial was funded by the National Institutes of Health. Dr. Bukowski and Dr. Mercer have disclosed no relevant financial relationships.Society for Maternal-Fetal Medicine 28th Annual Meeting: Abstract 5. Presented January 31, 2008. |
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