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Updated: Jun 20, 2026

Modifying Levels of Maternal Dietary Folic Acid or Choline to Study the Impact of Deficiencies on Offspring Health Outcomes
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Modifying Levels of Maternal Dietary Folic Acid or Choline to Study the Impact of Deficiencies on Offspring Health Outcomes

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Maternal folic acid supplement use in early pregnancy and child behavioural problems: The Generation R Study

Sabine J Roza1, Tamara van Batenburg-Eddes, Eric A P Steegers

  • 1The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.

The British Journal of Nutrition
|September 24, 2009
PubMed

Insights

Maternal folic acid use in early pregnancy is linked to better child behavior. Not using folic acid supplements increases the risk of behavioral and emotional problems in toddlers.

Area of Science:

  • Perinatal health
  • Developmental psychology
  • Nutritional science

Background:

  • Folate deficiency in embryogenesis is a known risk factor for fetal neural tube defects.
  • Adequate folate status is crucial for normal fetal growth and brain development.
  • The impact of maternal folic acid use on child behavioral development requires further investigation.

Purpose of the Study:

  • To investigate the association between maternal folic acid supplementation during pregnancy and child behavioral development.
  • To assess the risk of behavioral and emotional problems in children based on first-trimester folic acid use.

Main Methods:

  • Prospective, population-based cohort study.
  • Folic acid supplement use during the first trimester assessed via questionnaire.
  • Child behavioral and emotional problems evaluated using the Child Behaviour Checklist at 18 months in 4214 toddlers.

Main Results:

  • Children of mothers not using folic acid supplements in the first trimester showed a higher risk of total behavioral problems (OR 1.44).
  • Folic acid supplementation was associated with protection against both internalizing (OR 1.65) and externalizing problems (OR 1.45).
  • The association between folic acid use and child behavior was not mediated by birth weight or fetal head size.

Conclusions:

  • Inadequate folic acid supplementation during early pregnancy may be linked to an increased risk of behavioral issues in offspring.
  • Folic acid supplementation, beyond preventing neural tube defects, may also contribute to reducing mental health problems in children.

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