An optimal periconception maternal folate status for embryonic size: the Rotterdam Predict study
Article first published online: 12 FEB 2014
© 2014 Royal College of Obstetricians and Gynaecologists
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 121, Issue 7, pages 821–829, June 2014
How to Cite
An optimal periconception maternal folate status for embryonic size: the Rotterdam Predict study. BJOG 2014;121:821–829., , , , , , , , , .
- Issue published online: 20 MAY 2014
- Article first published online: 12 FEB 2014
- Manuscript Accepted: 13 NOV 2013
- Department of Obstetrics and Gynaecology
- Erasmus University Medical Centre
- Crown–rump length;
- embryonic growth;
- RBC folate
To investigate the association between periconception maternal folate status and embryonic size.
Prospective periconception cohort study.
Erasmus University Medical Centre, Rotterdam, the Netherlands.
Seventy-seven singleton pregnancies recruited in 2009 and 2010.
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.
In total, 484 ultrasound scans were performed in 77 women, in 440 (90.7%) of which CRLs 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; Poverall = 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.
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.