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An optimal periconception maternal folate status for embryonic size: the Rotterdam Predict study
Author(s) -
Uitert EM,
Ginkel S,
Willemsen SP,
Lindemans J,
Koning AHJ,
Eilers PHC,
Exalto N,
Laven JSE,
Steegers EAP,
SteegersTheunissen RPM
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12592
Subject(s) - quartile , medicine , confidence interval , pregnancy , gestation , prospective cohort study , obstetrics , gestational age , fetus , body mass index , biology , genetics
Objective To investigate the association between periconception maternal folate status and embryonic size. Design Prospective periconception cohort study. Setting Erasmus University Medical Centre, Rotterdam, the Netherlands. Population Seventy‐seven singleton pregnancies recruited in 2009 and 2010. Methods We recruited women before 8 weeks of gestation and performed weekly three‐dimensional ultrasound scans from enrolment up to 13 weeks of gestation. As a measure of embryonic growth, crown–rump length ( CRL ) measurements were performed using V‐Scope software in the BARCO I‐Space. Maternal blood was collected to determine first‐trimester long‐term red blood cell ( RBC ) folate status. Non‐malformed live births were included in the analysis. We calculated quartiles of RBC folate, square root‐transformed CRL data and performed multivariable linear mixed model analyses. Main outcome measures Serial first‐trimester CRL measurements. Results In total, 484 ultrasound scans were performed in 77 women, in 440 (90.7%) of which CRL s could be measured. RBC folate in the third quartile (1513–1812 nmol/l) was significantly associated with an increased CRL compared with the first two quartiles (814–1512 nmol/l) and the upper quartile (1813–2936 nmol/l; P overall  = 0.03; adjusted for gestational age, smoking, body mass index and fetal sex). Compared with the third quartile, embryos in the upper quartile were 24.2% smaller at 6 +0  weeks [4.1 mm (95% confidence interval 3.5, 4.7) versus 5.4 mm (95% confidence interval 4.8, 6.1)] and 7.6% smaller at 12 +0  weeks [55.1 mm (95% confidence interval 52.9, 57.3) versus 59.6 mm (95% confidence interval 57.4, 62.0)] of gestation. Conclusions This study suggests that a very high maternal periconception folate status is associated with reduced embryonic size. Whether these effects are beneficial or harmful requires further investigation.

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