Maternal Obesity and Pre-Pregnancy Folic Acid Supplementation

Abstract

Objective: The purpose of this nested cohort study was to compare the rate of pre-pregnancy supplementation in obese women with that of women with a normal BMI. Methods: Pregnant women were enrolled at their convenience in a large university hospital. Weight and height were measured in the first trimester and BMI categorised. Results: Of the 288 women, 35.1% were in the normal, 29.5% in the overweight and 35.4% in the obese BMI categories. Only 45.1% (n = 46) of the obese women took pre-pregnancy folic acid compared with 60.4% (n = 61) of women with a normal BMI (p < 0.03). The lower incidence of folic acid supplementation in obese women was associated with an unplanned pregnancy in 36.3% of women compared with 22.8% in the normal BMI category (p < 0.04). Conclusions: Obese women should take folate supplements whether they are planning to conceive or not.

Preconceptional folic acid‐containing supplement use in the national birth defects prevention study

“…Furthermore, the proportion of women following this recommendation was even lower among Hispanic and obese women in the NBDPS, despite the fact that women in both groups are at increased risk of having a child with a NTD (Waller et al, ; Carmichael et al, ; Anderson et al, ). These findings are consistent with previous reports (Canfield et al, ; Green‐Raleigh et al, ; Suellentrop et al, ; Case et al, ; Cueto et al, ; Farah et al, ), and highlight the continued need for programs aimed at increasing the proportion of reproductive age women who consume a folic acid supplement on a daily basis.…”

The relationship between gestational weight gain and fetal growth: time to take stock?

“…Furthermore, about half of all pregnancies are unintended, therefore, measured prepregnancy weights are often unavailable [14] . Unintended pregnancies due to failure of hormonal contraception may also be commoner in obese women [8] . Thus, the availability or non-availability of a pre-pregnancy weight measurement in itself is a potential source of epidemiological bias in studies of GWG.…”

“…Morbidly obese patients have been shown to have a high prevalence of micronutrient deficiencies [7] . Obese women have been shown to have lower folic acid levels and to have an increased risk of neural tube defects [8] . Micronutrient and macronutrient deficiencies in pregnancy are associated with poorer outcomes for both the mother and her baby [2] .…”

Trends in maternal obesity in a large university hospital 2009–2013

“…Other studies have used pre‐pregnancy measurements which are often not available, particularly if the pregnancy is unplanned. This is an important confounder because obese women are more likely to have an unplanned pregnancy . Finally, many studies are limited by including measurements calculated after 16–18 weeks' gestation when a woman has already started to gain weight .…”