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Maternal Folic Acid Supplementation, Perinatal Factors, and Pre-Adolescent Asthma: Findings from the Healthy Growth
Eva Karaglani1,2, Maria Michelle Papamichael3, Matzourana Argyropoulou1,2
1Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University of Athens, 17671 Athens, Greece.
Insights
Maternal folic acid supplementation in later pregnancy trimesters was linked to a modest increase in childhood asthma risk. Perinatal and environmental factors modified this association, suggesting complex interactions in asthma development.
Area of Science:
- Pediatric Allergy and Immunology
- Perinatal Epidemiology
- Environmental Health
Background:
- Folic acid's role in preventing neural tube defects is established, but its impact on pediatric asthma is uncertain.
- Limited evidence exists regarding maternal folic acid intake and childhood asthma development.
- Investigating perinatal and environmental modifiers is crucial for understanding this association.
Purpose of the Study:
- To examine the association between maternal folic acid supplementation and pre-adolescent asthma.
- To identify perinatal and environmental factors that modify this relationship.
Main Methods:
- Cross-sectional analysis of 2332 pre-adolescents (Healthy Growth Study).
- Data collected via questionnaires on sociodemographics, perinatal, and environmental factors.
- Logistic regression models assessed maternal folic acid intake (by trimester) and asthma prevalence.
Main Results:
- Third-trimester folic acid supplementation associated with 34% increased odds of pre-adolescent asthma.
- Increased asthma odds observed with second/third-trimester supplementation in preterm infants and those with non-smoking mothers.
- First-trimester supplementation linked to higher asthma odds in appropriate-for-gestational-age infants.
Conclusions:
- Maternal folic acid intake, especially in later pregnancy, shows a modest association with increased pre-adolescent asthma risk.
- Perinatal and environmental factors significantly modify this association.
- Further research needed on risks/benefits of folic acid supplementation beyond the first trimester.
Abstract:
Background: While the importance of folic acid supplementation during pregnancy in the prevention of neural tube defects in offspring is well established, its potential role in pediatric asthma development remains unclear, with limited evidence to date. Objective: To identify perinatal and environmental factors that modify the association between maternal folic acid intake and pre-adolescent asthma. Methods: Cross-sectional analysis of the Healthy Growth Study that consisted of 2332 pre-adolescents (mean age 11 years; asthma n = 451); 50% boys attending elementary schools in Greece. Questionnaires were used to collect data on sociodemographic, perinatal, and environmental characteristics as well as asthma prevalence and maternal folic acid supplementation during pregnancy (trimesters 1, 2, and 3). Logistic regression models explored the association between maternal folic acid supplementation and pre-adolescent asthma, accounting for perinatal and environmental exposures. Results: Adjusted regression models showed that maternal folic acid supplementation during the third trimester was associated with 34% increased odds of pre-adolescent asthma. Stratified analyses per perinatal and environmental factors revealed significantly higher asthma odds with folic acid supplementation during the second and third trimesters among pre-adolescents born < 37 weeks; non-smoking mothers; in pre-adolescents attending schools of low socioeconomic level; and in neighborhoods having less traffic and more parks. Contrastingly, in appropriate for gestational age (AGA), an infant's first-trimester supplementation increased asthma odds. Conclusions: Maternal folic acid supplementation, particularly in later trimesters, was modestly associated with increased odds of pre-adolescent asthma, modified by perinatal and environmental factors. Future research should explore whether continued folic acid supplementation beyond the first trimester carries differential risks or benefits in asthma.
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