Maternal Folate Status and Preterm Birth in the Boston Birth Cohort
Embargo until
2019-05-01
Date
2018-03-14
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Johns Hopkins University
Abstract
Preterm birth (PTB) is one of the most pressing challenges to maternal and child health in the United States (US). There remains an urgent need to identify important and modifiable risk factors for PTB among those most at risk- such as urban low income, Non-Hispanic blacks. This dissertation aimed to: i) evaluate the relationship between maternal folate status and risk of PTB and ii) investigate the biologic plausibility of the folate-PTB association by evaluating the role of folate on major pathogenic pathways leading to PTB –namely preeclampsia and intrauterine infection/inflammation (IUI). The analyses included 7565 mother-newborn dyads and a subsample (n=2313) with plasma folate assay at delivery in Boston Birth Cohort.
There was an inverse relationship between the frequency of multivitamin supplement intake and PTB. Compared to less frequent use, multivitamin supplement intake 3-5 times/week (adjusted odds ratio (aOR)= 0.78, 95% confidence interval (CI): 0.64, 0.96) or >5 times/week (aOR= 0.77, 95% CI: 0.64, 0.93) throughout pregnancy was associated with reduced risk of PTB. Multivitamin supplement intake of three or more times a week in the 3rd trimester was associated with reduced odds of preeclampsia (aOR=0.77, 95% CI: 0.65, 0.93). Each interquartile increase in plasma folate reduced the odds of preeclampsia by 20% (aOR=0.80, 95% CI: 0.68,0.95). Preeclampsia mediated 62% of the relationship between multivitamin supplement intake and medically indicated PTB. Multivitamin supplement intake of three or more times a week in the 3rd trimester (aOR=0.74, 95% CI: 0.63, 0.87) was associated with reduced odds of IUI. Each interquartile increase in plasma folate reduced the odds of IUI by 15% (aOR=0.85, 95% CI: 0.73, 0.98). Joint analysis of IUI and multivitamin supplement intake showed that multivitamin intake attenuated the relationship between IUI and PTB.
Findings from this study are relevant to policies and interventions, specifically among vulnerable populations. The results of this dissertation have a potential impact on ongoing research, clinical and programmatic efforts to improve prenatal nutrition and birth outcomes. Findings may inform the design and implementation of nutrition-based screening and interventions to prevent PTB and associated short-term and long-term consequences.
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Keywords
Maternal Folate Status, Preterm Birth