| Purposes: At present,the relationship between folic acid supplementation during different pregnancies and fetal growth and development and its impact on long-term fetal health have become the focus of attention.The results of this study are not uniform,and most studies have been on the association of periconceptional folic acid supplementation with fetal birth outcomes.Based on the birth cohort in Huaibei City,this study conducted a questionnaire survey of pregnant women included in the cohort during different pregnancies to obtain the use of folic acid supplements in pregnant women during different trimesters.The growth and development indicators of fetals in utero and at birth were monitored,the blood of pregnant women during different pregnancies was collected,and the correlation between folic acid supplementation,folate level related indicators,and fetal growth and development indicators was explored.Methods: A birth cohort was established in Huaibei Maternal and Child Health Care Hospital,and from November 2020 to September 2022,607 pregnant women who chose to undergo regular pregnancy tests in our hospital and successfully completed delivery were finally included in the study.Researchers who have undergone unified training and qualified assessment will use the questionnaire designed by this research group to carry out on-site investigations.The survey information mainly includes:general demographic information,folic acid(FA)supplement use,etc.The serum folic acid,serum homocysteine(Hcy)and red blood cell folate levels were measured in the early,middle and third trimester(12W,24 W,36W).Color Doppler ultrasound was used to measure parietal hip length,double parietal diameter,and head circumference in the first trimester,and double parietal diameter,head circumference,abdominal circumference,and femur length in the second and third trimesters.When a pregnant woman gives birth,her birth weight and length are measured.Categorical variables,expressed as percentages(%),are described by mean ± standard deviation when continuous variables follow a normal distribution,and folate levels,intrauterine growth and birth outcomes are compared between groups using analysis of variance and Kruskal-Wallis H test.The chi-square test was used to compare the incidence of large-for-gestational-age infants,small-for-gestational-age infants,low birth weight,and high birth weight between different supplementation groups in the periconceptional period and the second and third trimesters.Spearman and Perason were used to analyze the correlation between different folate level correlation indexes and fetal growth and development indexes,and multiple linear regression was used to analyze the influence of different folate level related indexes on fetal growth and development indexes.Results: According to statistics,607 pregnant women were included in this cohort,and only 186 people supplemented with folic acid before pregnancy;97.9% of people in the first trimester received folic acid supplementation;58.0% were supplemented with folic acid in the second trimester;Folic acid supplementation accounted for39.9% of the third trimester.1.In periconceptional folic acid supplementationCompared with the non-supplementation group during the periconceptional period,the serum folic acid supplementation group and the folic acid supplementation group started in the first trimester of pregnancy could significantly increase the levels of folate in the first trimester,and the levels of serum folic acid and red blood cell folate in the second trimester of the periconceptional folic acid supplementation group also increased significantly.There were no significant differences in intrauterine growth and development indicators and birth outcome between the three groups.2.In the second and third trimesters of folic acid supplementationCompared with the group without folic acid supplementation in the second and third trimesters,the group with continuous folic acid supplementation in the second and third trimesters and the group without folic acid supplementation in the second and third trimesters of pregnancy could significantly increase serum and red blood cell folate levels in the second and third trimesters,continued folic acid supplementation in the second and third trimesters reduce serum homocysteine levels in the third trimester.There were statistically significant differences in the medium-term double top diameter between the three groups(H=3.219,P=0.041),and there was no statistically significant difference in birth outcomes between groups.3.The correlation between folate levels and fetal growth and development indicators during different pregnanciesIn terms of the correlation between folic acid level and intrauterine development indexes,serum folic acid in the first trimester was positively correlated with head circumference in the second trimester(r=0.143,P=0.038)and with the second trimester abdominal circumference(r=0.142,P=0.039).Early serum homocysteine was negatively correlated with early head circumference(r=-0.139,P=0.044);The level of red blood cell folate in the first trimester was positively correlated with the double parietal diameter in the middle stage(r=0.145,P=0.035),with the head circumference in the middle stage(r=0.170,P=0.014),and with the length of the femur in the middle stage(r=0.146,P=0.034).No correlation between intermediate and late folate levels and related indicators and intrauterine growth and development indicators was found.In terms of the correlation between folate level and neonatal growth and development,serum folic acid in early pregnancy was positively correlated with fetal length(r=0.148,P=0.032).Serum homocysteine levels in the second trimester were negatively correlated with gestational age(r=-0.180,P=0.021),and erythrocyte folate levels in the second trimester were positively correlated with newborn length length(r=0.209,P=0.007).4.In terms of the effect of different folate levels on fetal birth outcomes After dividing the levels of folic acid and Hcy in three equal parts of pregnancy,the comparison showed that there were statistical differences in the gestational age of delivery between groups with different serum homocysteine levels in the second trimester(F=4.508,P=0.012),and there were significant differences in neonatal length between groups with different erythrocyte folate levels in the second trimester(F=3.086,P=0.048).With T1 as the control group,serum T2 and T3 levels increased birth length in early stage,and intermediate homocysteine T2 and T3 levels decreased gestational age in labor.Late RBC folate T2 levels increase birth body length.Compared with the group with normal folic acid level in the second trimester and the group with insufficient folic acid level,there was a significant difference in the length of the two groups(t=2.782,P=0.006),and the difference in neonatal length between the two groups in the third trimester was also statistically significant(t=2.127,P=0.035).Conclusions: This study found that regular folic acid supplementation during the periconceptional period can increase the level of folic acid in the first and second trimesters,and on the basis of folic acid supplementation during the periconceptional period,continuous folic acid supplementation in the second and third trimesters can increase the level of folic acid in the second and third trimesters of pregnancy,and reduce the level of serum homocysteine in the third trimester.Serum folic acid level in early pregnancy was positively correlated with head circumference,abdominal circumference and neonatal length in the second trimester,red blood cell folate level in early pregnancy was positively correlated with double parietal diameter,head circumference and femur length in the second trimester,red blood cell folate level in the second trimester was positively correlated with neonatal length,and serum homocysteine level in the second trimester was negatively correlated with the gestational week of delivery.There was a statistically significant difference in length between the group with normal folate levels in the second and third trimesters of pregnancy and the group with insufficient folate levels. |
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