| Objective: Currently,the effect of folic acid supplementation of pregnant women on their own and long-term fetal and even infant development has become the focus of more and more studies,while studies on the effect of folic acid on placental development,which is the support of infant development,are limited.In this study,we obtained the indicators related to placental development in this population through a survey of pregnant women who had their cards established in a hospital in Huaibei City.Folic acid supplementation and folic acid levels were obtained through questionnaires and blood samples to explore the association between them and placental development.Methods: From November 2020 to October 2021,a survey was conducted in a hospital in Huaibei City,and pregnant women who had their cards established in the hospital were selected and eventually included in the study of 256 people.The face-to-face survey was conducted by trained professionals according to the questionnaire designed by our group,which was tested for reliability and validity.The survey included demographic data,anthropometric data,and folic acid（FA）intake.Erythrocyte folate,serum folate and serum peer cysteine（Homocysteine,Hcy）levels were measured in fasting blood samples at each trimester（12W,24 W,36W）.Placental thickness,umbilical artery systolic pressure/diastolic pressure（Ut A-S/D）,and umbilical artery resistance index（Ut A-RI）were measured by color Doppler ultrasound at each trimester.The ultrasound-resistance index（Ut A-RI）.The length,width,thickness,and weight of the delivered placenta,the length of the umbilical cord,and the volume of amniotic fluid were measured at the time of delivery.All categorical variables,expressed as percentages（%）,were compared by t-test,ANOVA,Mann-Whitney U-test or Kruskal-Wallis H-test for normally distributed continuous variables,respectively,to determine whether there was a difference between folic acid use,length of folic acid use and placental development indicators during pregnancy and delivery.Multiple linear regression was used to analyze the relationship between folic acid and placenta-related indicators,and Spearman’s correlation was used to analyze the relationship between folic acid levels and placenta-related indicators at the time of delivery.Results:A total of 313 participants were surveyed in this study,and 256 pregnant women were finally included.The mean age of the surveyed subjects was 28.18±4.34 years,of which 75（29.3%）took folic acid before pregnancy,236（92.2%）took folic acid in early pregnancy,99（38.7%）pregnant women took folic acid in mid pregnancy,and 86（33.6%）took folic acid in late pregnancy.1.In terms of folic acid taking and blood levels,compared to those who did not supplement,pre-pregnancy folic acid supplementation in early Erythrocyte folate levels were significantly higher（P<0.05）;early folic acid supplementation increased early erythrocyte folate and early serum folate levels,both with P values <0.05;on the basis of early folic acid supplementation in early pregnancy,folic acid supplementation in mid-pregnancy increased mid-term erythrocyte folate（P<0.05）and increased mid-term serum folate（P<0.05）compared with no supplementation;on the basis of early and mid-term folic acid supplementation On top of early and midterm folic acid supplementation,late folic acid supplementation increased late erythrocyte folate levels（P<0.05）and increased serum folate levels（P<0.05）.After adjusting for age at the time of card construction,BMI,residence in the last six months,household registration,nature of work,education level,fetal sex,smoking,and alcohol consumption,the association between the presence or absence of folic acid supplementation during pregnancy and indicators of placental development during pregnancy showed that midterm folic acid supplementation significantly increased midterm placental thickness [β=0.126,95% CI:（0.019,0.232）,P=0.021].No statistical significance was observed between folic acid intake during pregnancy and placental indicators at delivery（P>0.05）.2.In terms of duration of intake,ANOVA showed that the difference in duration of intake in mid-pregnancy was observed to be statistically significant（P<0.05）in terms of placental thickness in mid-late pregnancy,while after multiple linear regression,adjusting for age and BMI,residence in the last six months,household registration,nature of work,educational level,fetal sex,smoking,and alcohol consumption,it was found that,compared to duration of intake 0 days,duration of intake in pre-pregnancy and placental thickness in mid-pregnancy It was observed that taking duration >55 days increased midterm placental thickness [β=0.116,95% CI:（0.003,0.229）,P=0.044],early folic acid supplementation duration >55 days decreased late placental thickness[ β =-0.185,95% CI:（-0.335,0.014）,P=0.034],and midterm folic acid supplementation duration > 55 days increased mid-term placental thickness [β=0.117,95% CI:（0.031,0.203）,P=0.008].Statistical significance was observed between the length of midterm folic acid supplementation and amniotic fluid volume at delivery（P<0.05）,with no significant difference between other relevant indicators（P>0.05）.3.Regarding the doses taken,ANOVA showed that the different pre-pregnancy dose groups showed significant differences in early placental thickness（P<0.05）,and statistically significant differences were also observed between the different mid-term dose groups in mid-term placental thickness（P<0.05）,using the unsupplemented group as the control group,after adjusting for age,BMI,education level,residence in the last six months,smoking,alcohol consumption,nature of work,fetal After multiple regression analysis,compared with no folic acid,a dose of >0.4 mg increased early placental thickness by 0.185 cm [95% CI:（0.018,0.352）,P=0.030] before pregnancy and a dose of >0.4 mg of folic acid supplementation in early pregnancy decreased mid-term Ut A-RI by 0.054 [95% CI:（-0.092,-0.015）,P=0.007],taking in folic acid at dose 0.4 mg in midterm increased midterm placental thickness by 0.133 cm compared to no dose [95% CI:（0.045,0.222）,P=0.003],no statistical significance was observed between other dose subgroups and placental developmental indicators during pregnancy,and the association between dose taken before pregnancy and No statistical significance was observed between other dose groups and placental developmental indicators during pregnancy,and no statistical significance was observed between pre-pregnancy doses and placental thickness at delivery（P<0.05）,and between early pregnancy doses and umbilical cord length at delivery（P<0.05）.4.In terms of folate and homocysteine levels,compared to the lowest quartile levels,the second and fourth quartile early folate levels decreased midterm Ut A-RI 0.057[95% CI:（-0.114,0.000）,P=0.048],0.007 [95% CI:（-0.154,-0.034）,P=0.003],respectively,and midterm The second quartile level of erythrocyte folate significantly reduced mid-term Ut A-RI compared to the lowest quartile level [β=-0.041,95% CI:（-0.081,-0.001）,P=0.046],while in the late stage,the highest quartile of erythrocyte folate significantly reduced late placental thickness compared to the lowest quartile level [β=-0.215,95% CI:（-0.427,-0.004）,P=0.046],and the second quartile level of serum folate in the late stage significantly increased placental thickness [ β =0.305,95% CI:（0.027,0.583）,P=0.032].After correlation analysis of folic acid levels at each trimester with placental indicators at delivery,there was a negative correlation between erythrocyte folate in the midterm and placental thickness at delivery（r=-0.472,P=0.020）.Conclusion: In this study,we found that continuous folic acid supplementation in early pregnancy on top of midterm folic acid increased placental thickness during pregnancy;with the length of midterm folic acid supplementation positively correlated with midterm placental thickness;the dose of pre-pregnancy folic acid supplementation positively correlated with placental thickness in early pregnancy and at delivery,and the dose of midterm folic acid supplementation positively correlated with midterm placental thickness;the increase in early and midterm folic acid levels decreased midterm Ut A-RI,and late folic acid compared with the lowest quartile level,serum folic acid levels in the range of 5.35 to 8.61 ng/m L increase placental thickness,while erythrocyte folic acid greater than 608.74 ng/m L decreases placental thickness. |
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