Folic Acid Supplements in Pregnancy and Severe Language Delay in Children | Child Development | JAMA | JAMA Network
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Original Contribution
October 12, 2011

Folic Acid Supplements in Pregnancy and Severe Language Delay in Children

Author Affiliations

Author Affiliations: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway (Drs Roth, Schjølberg, and Reichborn-Kjennerud); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (Drs Magnus, Stoltenberg, and Surén); Department of Biostatistics (Dr McKeague), Department of Epidemiology, Mailman School of Public Health (Dr Susser), and Imprints Center for Genetic and Environmental Life Course Studies (Drs Roth and Susser), Columbia University, New York, New York; MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, England (Dr Davey Smith); Institute of Psychiatry, University of Oslo, Oslo, Norway (Dr Reichborn-Kjennerud); and New York State Psychiatric Institute, New York (Dr Susser).

JAMA. 2011;306(14):1566-1573. doi:10.1001/jama.2011.1433
Abstract

Context Prenatal folic acid supplements reduce the risk of neural tube defects and may have beneficial effects on other aspects of neurodevelopment.

Objective To examine associations between mothers' use of prenatal folic acid supplements and risk of severe language delay in their children at age 3 years.

Design, Setting, and Patients The prospective observational Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and December 2008. Data on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 16, 2010, were used. Maternal use of folic acid supplements within the interval from 4 weeks before to 8 weeks after conception was the exposure. Relative risks were approximated by estimating odds ratios (ORs) with 95% CIs in a logistic regression analysis.

Main Outcome Measure Children's language competency at age 3 years measured by maternal report on a 6-point ordinal language grammar scale. Children with minimal expressive language (only 1-word or unintelligible utterances) were rated as having severe language delay.

Results Among 38 954 children, 204 (0.5%) had severe language delay. Children whose mothers took no dietary supplements in the specified exposure interval were the reference group (n = 9052 [24.0%], with severe language delay in 81 children [0.9%]). Adjusted ORs for 3 patterns of exposure to maternal dietary supplements were (1) other supplements, but no folic acid (n = 2480 [6.6%], with severe language delay in 22 children [0.9%]; OR, 1.04; 95% CI, 0.62-1.74); (2) folic acid only (n = 7127 [18.9%], with severe language delay in 28 children [0.4%]; OR, 0.55; 95% CI, 0.35-0.86); and (3) folic acid in combination with other supplements (n = 19 005 [50.5%], with severe language delay in 73 children [0.4%]; OR, 0.55; 95% CI, 0.39-0.78).

Conclusion Among this Norwegian cohort of mothers and children, maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years.

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