It is well known that women of childbearing age are recommended to take a supplement that contains folic acid, this is due to the fact that folate (folate is the naturally occurring form of folic acid) in very early pregnancy, before most women even know they are pregnant, can reduce the risk of birth defects especially spina bifida. Unfortunately many women in the UK do not achieve good levels of folate in their daily diets or through supplements. A concern in the UK is the rising levels of teenage pregnancy, these young women are often not taking nutrient supplements when they get pregnant and their diets may also be lacking in the vitamins, minerals and essential fatty acids that are vital for the developing foetus.
There may be additional benefits to taking folic acid supplements before conceiving a child. A new study(1) has found that folic acid supplements prior to conception (and in early pregnancy) may help prevent premature births. The study links early and pre-pregnancy folic acid intakes to a reduced risk of premature births. Prevention of premature birth is very important, infants born early, before 37 weeks of pregnancy rather than the normal 40 weeks, have an increased risk of many health and developmental problems.
It has previously been shown that women who deliver premature babies tend to have lower levels of folate in their blood but this study(1) wanted to look at the effect of folate supplementation on rates of premature birth. The researchers assessed 34,480 pregnant women, about 20% of these had been taking folate supplements for a year or more before getting pregnant, 36% had been taking them for less than a year and 44% were not taking any supplements at all. 160 of the women delivered their babies before 32 weeks of pregnancy while 1,658 women delivered their babies before 37 weeks.
The data showed that using folate supplements for a year or more was associated with a 70% reduced risk of delivering a baby at 20-28 weeks. Taking the supplements for less than a year was linked to 50% reduced risk of premature births compared to women who did not take supplements. For deliveries between 28-32 weeks the risk was 50% lower for women on supplements for a year or longer and 30% lower for those taking supplements for less than a year compared to those women not taking supplements. There was no relationship between folate supplement use and risk of delivering a baby between 32 and 37 weeks’ gestation. The preventive effects of supplementation were most powerful for preventing the earliest, and hence riskiest, preterm births.
In brief: These findings show that folate supplementation for a year or more before conception is associated with a 50%–70% decrease in early, but not late, spontaneous preterm births and that the longer a woman takes folate supplements before becoming pregnant, the lower her risk of a preterm birth. The study only shows a possible association between folate supplementation and reduction in the risk of premature birth. Further randomised trials are necessary to provide confirmation of the link. It could be that taking supplements is a general marker for healthy behaviour. However, there is a body of evidence that suggests there could be biological reasons why folate may protect against premature birth. Low folate levels are associated with increased intrauterine infection which is linked to early premature births. Folate also seems to reduce inflammation within the body during pregnancy. Since folate is necessary preconceptionally and in the early weeks of pregnancy in order to prevent birth defects it is definitely worth considering long term supplementation prior to conception.
It is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates. It may also be worth considering a broad-spectrum food-state supplement specifically designed for pre-pregnancy in order to main good levels of all nutrients. An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten. Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.
(1) Bukowski et al. 2009. Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study. PLoS Medicine. 6 (5): e1000061 DOI: 10.1371/journal.pmed.1000061
Written by Ani Kowal
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