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Published on: June 28, 2024
Maternal Folic Acid Supplementation During Pregnancy and Early Childhood Asthma
Sreenivas P Veeranki1, Tebeb Gebretsadik, Edward F Mitchel
1From the Divisions of aGeneral Pediatrics, bPediatric Allergy, Immunology, and Pulmonary Medicine, cAllergy, Pulmonary and Critical Care Medicine, dCenter for Asthma and Environmental Sciences Research, eDepartments of Pediatrics, fMedicine, gHealth Policy, hBiostatistics, Vanderbilt University School of Medicine, Nashville, TN; iDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN; and jDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Insights
Timing of folic acid prescription fills during pregnancy is linked to childhood asthma. Exposure in the first trimester increased asthma risk, while later exposure showed no association, impacting child respiratory health.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Epidemiology
Background:
- Asthma is a prevalent chronic childhood illness.
- Folic acid supplementation is recommended for preventing neural tube defects.
- Previous research on folic acid and respiratory diseases yielded conflicting results.
Purpose of the Study:
- To examine the association between the timing of folic acid prescription fills during pregnancy and the development of childhood asthma.
- To investigate if prenatal folic acid exposure influences respiratory health outcomes in children.
Main Methods:
- A retrospective cohort study included 104,428 children and their mothers from Tennessee Medicaid (1996-2005).
- Women were categorized by folic acid prescription filling timing relative to the first trimester.
- Childhood asthma was defined by healthcare visits and medication fills at ages 4.5-6 years.
Main Results:
- 15% of children were diagnosed with asthma.
- Exposure to folic acid prescriptions in the first trimester (only or later) was associated with increased odds of childhood asthma (aOR=1.2).
- Exposure to folic acid prescriptions after the first trimester showed no association with childhood asthma.
Conclusions:
- The timing of folic acid prescription filling during pregnancy is significantly associated with childhood asthma risk.
- Prenatal nutritional supplement timing may play a role in child respiratory health.
- Further research is warranted to elucidate the mechanisms behind this association.
Background:
Asthma is one of the most common chronic childhood diseases. While folic acid supplementation around conception helps prevent neural tube defects, an animal model suggests that it may be a risk factor for respiratory diseases, although epidemiologic studies have had conflicting results. We investigated the timing of folic acid-containing prescription filling during pregnancy and child asthma.
Methods:
In a retrospective cohort study of 104,428 children, born 1996-2005, and their mothers enrolled in Tennessee Medicaid, we investigated the association of filling folic acid-containing prescriptions during pregnancy and childhood asthma at ages 4.5-6 years. We categorized women into exposure groups based on prescription filling centered around the first trimester: no folic acid prescription exposure, exposure in first trimester only, exposure after first trimester, and exposure in first trimester and beyond. We defined asthma using asthma-specific healthcare visits and medication fills. Using logistic regression models, we investigated the relationship adjusting for potential confounders.
Results:
Overall 15% of children had asthma. Compared with children born to women with no folic acid prescription exposure, children born to women with exposures in the first trimester only or first trimester and later had increased relative odds of asthma (adjusted odds ratios = 1.2, 95% confidence interval = 1.1, 1.3, and 1.2, 95% confidence interval = 1.2, 1.3); no association was seen in children born to women exposed after the first trimester.
Conclusion:
Timing of folic acid-containing prescription filling during pregnancy was associated with childhood asthma. Our findings contribute to understanding of the role of prenatal nutritional supplements on child respiratory health.
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