A Cohort Study On The Effect Of Folic Acid Supplementation During Pregnancy On Adverse Pregnancy Outcomes And Infant Intelligence Development

Objective To explore the effect of folic acid supplementation at different times during pregnancy on adverse pregnancy outcomes?including hypertensive disorders of pregnancy,gestational diabetes mellitus,pregnancy-associated anemia,fetal macrosomia,etc?and related indicators.And the effect of folic acid supplementation and maternal nutrient levels on mental development of infants during pregnancy.It provides a theoretical basis for the formulation of relevant policies during pregnancy and nutrition counseling before and during pregnancy.Method?1?From October 2015 to August 2016,491 pregnant women were recruited at Jurong Maternal and Child Health Hospital.The basic information of pregnant women was obtained through questionnaire survey.Pregnancy lifestyle,marital status,vitamin and mineral supplements during pregnancy;Follow-up survey of pregnant women until production,detailed records of delivery manners and birth of newborns and other information;follow-up for newborns and record their birth information on growth and development,feeding methods,daily outdoor activity time,daily vitamin D supplementation dose at the time of physical examination at 1,3,6,8 and 12 months of age.?2?491 pregnant women to be enrolled were screened according to the inclusion and exclusion criteria,and 478 pregnant women were eventually included for follow-up.According to the diagnostic criteria of the disease,it is determined whether the pregnant woman is sick or not.According to whether supplement folic acid during pregnancy and the opportunity to start supplementation divide pregnant women into three groups,no folic acid supplementation group,start of post-pregnancy supplementation group,and start of pre-pregnancy supplementation group.The incidence of adverse pregnancy outcomes and the differences in disease-related indicators were compared among the three groups.Collect blood samples when pregnant women enter the hospital waiting for production and measure the concentrations of its folate,vitamin B₁₂,and homocysteine.Logitics regression analysis was used to investigate the effects of maternal serum folic acid,vitamin B₁₂,and Hcy levels on pregnancy outcomes.?3?Collect maternal postpartum colostrum and determine the concentration of folate and vitamin B₁₂ in colostrum.Follow-up of 478 pregnant women and their corresponding infants and record the Developmental Screen Test scores at 1,3,6,8 and 12 month of age.Analyze the effect of maternal folic acid supplementation and the timing of supplementation during pregnancy,as well as the effect of maternal low folate,low vitamin B₁₂ levels,and high Hcy levels on infant mental development.Result?1?491 pregnant women who were recruited in the previous period had no smoking habit during pregnancy,but 2.24%and 2.04%of pregnant women had occasional and regular drinking during pregnancy.There were 433 pregnant women who regularly took folic acid during pregnancy,accounting for 88.19%.Among the pregnant women who received folic acid,only 19.63%of pregnant women started supplementing from the time of conception and reached a dose of 0.4 mg/d or more;only 221 cases were exclusively breastfed within 6 months after birth,which 50%of the number of follow-up infants was not reached.More than half of the infants'fosterers have smoking habits.The overweight rate of infants at 3,6 and 8 month old is higher than that of 20%.?2?Vitamin B₁₂ concentration was positively correlated with folate concentration and negatively correlated with Hcy concentration.Serum homocysteine concentration was negatively correlated with folate concentration.Folic acid supplementation during pregnancy can increase serum folate levels,but there were no statistically significant difference in serum vitamin B₁₂ and Hcy levels.Compared to the no supplementation group,the incidence of anaemia in pregnancy,HDP,and premature rupture of membranes were lower in women who had received folic acid?0.2-0.8 mg/d?starting after pregnancy or before pregnancy?P<0.05?.The three groups of pregnant women had the highest Hb concentration in the start supplement before pregnancy group and the lowest Hb concentration in the no folic acid supplementation group.Folic acid supplementation had little effect on blood pressure,but there was still a statistical difference among the three groups.It was the lowest blood pressure in the supplemented group after pregnancy.No effect of serum folate,vitamin B₁₂,and Hcy levels on HDP and blood pressure was observed.?3?No effect of folic acid supplementation on the mental development of infants was observed.However,compared with the normal group,infants in the low serum folate group had a score of 0.12 points lower in the intellectual energy zone?95%CI:-0.23^-0.01,P=0.04?,and infants with the high Hcy level scored 1.30points lower than the lower-level group?95%CI:-2.52^-0.08,P=0.04?.In the colostrum low-vitamin B₁₂level group,infants scored 0.10 points lower?95%CI:-1.84 to-0.02,P=0.02?in the social adaptation zone compared to the normal group.Conclusion?1?The proportion of pregnant women who start supplement regular folic acid before pregnancy and the dose reached 0.4mg/d or above was lower in Jurong maternal and child health care hospital.The knowledge of folic acid supplementation for women during pregnancy or preparing for pregnancy should be popularized.The proportion of exclusive breastfeeding within 6 months of infants is not high,and the influencing factors are subject to follow-up studies;the proportion of overweight at 3,6 and 8 months of age after birth is higher than that of newborns.20%,and more than half of the infants'fosterers have smoking habits.?2?Folic acid supplementation during pregnancy?0.2⁰.8mg/d?can increase serum folate levels,but there is no statistically significant difference in serum vitamin B₁₂ and Hcy concentrations.Folic acid supplementation?0.2⁰.8mg/d?can be reduced The incidence of anemia and HDP in pregnancy.However,the possible mechanism is not just lower blood pressure and serum markers changes to reduce the risk of HDP.Folic acid supplementation also has less effect on prenatal blood pressure,but needs to be verified by a large sample population.?3?Pre-pregnancy and post-pregnancy folic acid supplementation may have no effect on infant mental development.Maternal low folate level and high homocysteine level may have an impact on the intellectual development of infants.The level of vitamin B₁₂ in colostrum may have effects on infant social adaptive capacity.This result may be caused by individual differences in folate and Hcy metabolism in pregnant women.