Periconceptional folic acid supplementation and risk of parent-reported asthma in children at 4–6 years of age

Jufen, Liu; Li, Zhiwen; Ye, Rongwei; Ren, Aiguo

doi:10.1183/23120541.00250-2019

Cited by 9 publications

(9 citation statements)

References 45 publications

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“…Two later studies [ 137 , 138 ] indicated that folic acid supplementation, depending on when it was started (3 rd trimester vs. 1 st trimester or earlier) and how long it was taken, increased the risk of the development of childhood asthma. However, the data have to be interpreted with caution and were not confirmed by two current intervention studies [ 139 , 140 ]. It has also been indicated that the impact of folic acid supplementation on the child’s lung function could be modified depending on the presence of a gene polymorphism of methylenetetrahydrofolate reductase (MTHFR C677T polymorphism) in the pregnant woman [ 133 ].…”

Section: Discussionmentioning

confidence: 71%

S3 Guideline Allergy Prevention

Kopp¹,

Muche-Borowski²,

Abou-Dakn³

et al. 2022

ALS

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Background: The persistently high prevalence of allergic diseases in Western industrial nations and the limited possibilities of causal therapy make evidence-based recommendations for primary prevention necessary. Methods: The recommendations of the S3 guideline Allergy Prevention, published in its last version in 2014, were revised and consulted on the basis of a current systematic literature search. The evidence search was conducted for the period 06/2013 – 11/2020 in the electronic databases Cochrane and MEDLINE, as well as in the reference lists of current reviews and through references from experts. The literature found was screened in two filtering processes, first by title and abstract, and the remaining papers were screened in the full text for relevance. The studies included after this were sorted by level of evidence, and the study quality was indicated in terms of potential bias (low/high). The revised recommendations were formally agreed and consented upon with the participation of representatives of the relevant professional societies and (self-help) organizations (nominal group process). Of 5,681 hits, 286 studies were included and assessed. Results: Recommendations on maternal nutrition during pregnancy and breastfeeding as well as on infant nutrition in the first months of life again play an important role in the updated guideline: Many of the previous recommendations were confirmed by the current data. It was specified that breastfeeding should be exclusive for the first 4 – 6 months after birth, if possible, and that breastfeeding should continue with the introduction of complementary foods. A new recommendation is that supplementary feeding of cow’s milk-based formula should be avoided in the first days of life if the mother wishes to breastfeed. Furthermore, it was determined that the evidence for a clear recommendation for hydrolyzed infant formula in non-breastfed infants at risk is currently no longer sufficient. It is therefore currently recommended to check whether an infant formula with proven efficacy in allergy prevention studies is available until the introduction of complementary feeding. Finally, based on the EAACI guideline, recommendations were made for the prevention of chicken egg allergy by introducing and regularly giving thoroughly heated (e.g., baked or hard-boiled) but not “raw” chicken egg (also no scrambled egg) with the complementary food. The recommendation to introduce peanut in complementary feeding was formulated cautiously for the German-speaking countries: In families who usually consume peanut, the regular administration of peanut-containing foods in age-appropriate form (e.g., peanut butter) with the complementary diet can be considered for the primary prevention of peanut allergy in infants with atopic dermatitis (AD). Before introduction, a clinically relevant peanut allergy must be ruled out, especially in infants with moderate to severe AD. There is still insufficient evidence for an allergy-pre...

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Section: Discussionmentioning

confidence: 71%

S3 Guideline Allergy Prevention

Kopp¹,

Muche-Borowski²,

Abou-Dakn³

et al. 2022

ALS

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“…These studies were published between 2006 and 2022, involving 252,770 participants, including 50,248 children with asthma. Seven studies were conducted in Europe ( 37 , 39 , 42 , 43 , 45 , 46 , 48 ), five in North America ( 35 , 36 , 38 , 40 , 49 ), four in Asia ( 32 – 34 , 44 ) and two in Australia ( 41 , 47 ). The included studies adjusted for potential confounders, such as maternal age, race, parity, education level, smoking history, asthma history, infant sex, birth weight, mode of delivery, and feeding method.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the scores for study quality ranged from 5 to 8. Twelve original studies ( 32 , 33 , 36 – 38 , 40 – 42 , 44 – 46 , 49 ) were assessed as high quality, and six ( 34 , 35 , 39 , 43 , 47 , 48 ) assessed as medium quality.…”

Section: Resultsmentioning

confidence: 99%

“…Another subgroup analysis was conducted according to the economic development level of different countries. Eleven studies ( 33 , 35 , 37 , 39 , 41 – 46 , 49 ) were included in the analysis of high-income economies (OR = 1.05; 95% CI = 1.01–1.09), and two studies ( 32 , 34 ) were included in the analysis of middle-income economies (OR = 1.26; 95% CI = 1.13–1.41). However, no literature was available for the analysis of low-income economies.…”

Section: Resultsmentioning

confidence: 99%

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Relationship between maternal folic acid supplementation during pregnancy and risk of childhood asthma: Systematic review and dose-response meta-analysis

et al. 2022

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Growing evidence suggests that maternal folic acid supplementation during pregnancy may be associated with the risk of childhood asthma, but these findings remain controversial. Therefore, the purpose of this systematic review and meta-analysis was to assess the association between maternal folic acid supplementation during pregnancy and the risk of childhood asthma, and to determine the safe dose of folic acid supplementation during pregnancy based on a dose-response analysis to lower the risk of childhood asthma. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies published before April 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of eligible studies, and a fixed-effect model was employed to calculate the odds ratio (OR) of asthma with 95% confidence intervals (CI). In addition, the generalized least-squares trend (GLST) was used to explore a nonlinear dose-response relationship. Stata 15.0 was used for the statistical analysis mentioned above. This systematic review included 18 studies (13 cohort studies, 5 case-control studies) with a total of 252,770 participants, 50,248 of whom were children with asthma. The meta-analysis showed that maternal folic acid supplementation during pregnancy was significantly associated with the risk of childhood asthma (OR = 1.07; 95% CI = 1.04–1.11). The subgroup analysis revealed a significant correlation between the risk of childhood asthma and the folic acid supplementation in the first Trimester (OR = 1.09; 95% CI = 1.05–1.12), the third Trimester (OR = 1.15; 95% CI = 1.04–1.26) and the whole pregnancy (OR = 1.13; 95% CI = 1.10–1.16). At the same time, the dose-response analysis showed a nonlinear relationship between maternal folic acid intake during pregnancy and the risk of childhood asthma. The risk of asthma in children significantly increased when maternal folic acid intake reached 581 μg/day. This meta-analysis showed that maternal folic acid supplementation during pregnancy increased the risk of asthma in children. Based on the results of the dose-response analysis, less than 580 μg folic acid per day is advised in order to effectively prevent birth defects without increasing the risk of childhood asthma.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42022332140.

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“…Such changes have been associated with enhanced severity of allergic airway disease. (12) Several observational cohort studies have reported inconsistent associations between higher prenatal folic acid or folate intakes and risk of allergic disease in the offspring (13)(14)(15)(16) (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) however many rely on dietary assessment to measure exposure. Of the studies that examined biomarkers to determine exposure, only one differentiated between specific forms of folate (20).…”

Section: Introductionmentioning

confidence: 99%

Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study

Best

Green

Sulistyoningrum

et al. 2021

The Journal of Nutrition

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Background The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. Objective We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy. Methods The cohort consisted of 561 mother–infant pairs from Western Australia. To be eligible the infant had to have a first-degree relative (mother, father, or sibling) with a history of medically diagnosed allergic disease. Maternal venous blood was collected between 36 and 40 wk of gestation. Serum UMFA was measured by LC–tandem MS. Serum total folate was determined using a microbiological method with chloramphenicol-resistant Lactobacillus rhamnosus as the test organism, and was collected between 36 and 40 wk of gestation. UMFA concentrations were measured by tandem MS using stable isotope dilution; folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid-treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization, and medically diagnosed wheeze were assessed at 1 y of age. Results Median (IQR) concentrations for UMFA and serum folate were 1.6 (0.6–4.7) and 53.2 (32.6–74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization, and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes. Conclusions In this cohort of children at high risk of allergic disease there was no association between maternal UMFA or serum folate concentrations measured in late pregnancy and allergic disease outcomes at 1 y of age.

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Periconceptional folic acid supplementation and risk of parent-reported asthma in children at 4–6 years of age

Cited by 9 publications

References 45 publications

S3 Guideline Allergy Prevention

S3 Guideline Allergy Prevention

Relationship between maternal folic acid supplementation during pregnancy and risk of childhood asthma: Systematic review and dose-response meta-analysis

Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study

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