Associations of maternal folic acid supplementation and folate concentrations during pregnancy with foetal and child head growth: the Generation R Study

Purpose Folic acid supplementation during pregnancy \nhas been associated with a reduced risk of common neurodevelopmental delays in the offspring. However, it is \nunclear whether low folate status has effects on the \ndeveloping brain. We evaluated the associations of \nmaternal folic acid supplementation and folate concentrations during pregnancy with repeatedly measured prenatal \nand postnatal head circumference in the offspring. \nMethods Within a population-based prospective cohort, \nwe measured maternal plasma folate concentrations at \napproximately 13 weeks of gestation (90 % range \n10.5\xe2\x80\x9317.2) and assessed folic acid supplementation by \nquestionnaire (2001\xe2\x80\x932005). Up to 11 repeated measures of \nhead circumference were obtained during foetal life (20 \nand 30 weeks of gestation) and childhood (between birth \nand age 6 years) in 5866 children (2002\xe2\x80\x932012). \nResults In unadjusted models, foetal head growth was \n0.006 SD (95 % CI 0.003; 0.009, P\\0.001) faster per \nweek per 1-SD higher maternal folate concentration. After \nadjustment for confounders, this association was attenuated \nto 0.004 SD per week (95 % CI 0.000; 0.007, P = 0.02; \nestimated absolute difference at birth of 2.7 mm). The \nassociation was independent of overall foetal growth. No \nassociations were found between maternal folate concentrations and child postnatal head growth. Preconceptional \nstart of folic acid supplementation was associated with \nlarger prenatal head size, but not with prenatal or postnatal \nhead growth. \nConclusions Our results suggest an independent, modest \nassociation between maternal folate concentrations in early \npregnancy and foetal head growth. More research is needed \nto identify whether specific brain regions are affected and \nwhether effects of folate on foetal head growth influence \nchildren\xe2\x80\x99s long-term functioning

Prenatal Depression and Adverse Birth Outcomes: An Updated Systematic Review

Complications related to preterm birth (PTB) and low birth weight (LBW) are leading causes of infant morbidity and mortality. Prenatal depression is a hypothesized psychosocial risk factor for both birth outcomes. The purpose of this systematic review was to examine evidence published between 1977 and 2013 on prenatal depression and risks of these primary adverse birth outcomes. A systematic search of the PUBMED and PsycINFO databases was conducted to identify studies testing the associations between prenatal depressive symptoms, or diagnoses of depression, and risk of PTB or LBW. We systematically selected 50 published reports on PTB and length of gestation, and 33 reports on LBW and BW. Results were reviewed by two independent reviewers and we evaluated the quality of the evidence with an established systematic review method, the Newcastle Ottawa Scale. We then undertook a narrative synthesis of the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Less than a quarter of 50 published reports found that prenatal depression was significantly associated with PTB or gestational age. In contrast, slightly more than half of the 33 reports found that prenatal depression was associated with LBW or BW. When weighing methodological features, we determined that the effects of prenatal depression on LBW are more consistent than effects on length of gestation or PTB. Although the evidence may not be strong enough to support routine depression screening for risk of adverse outcomes, screening to enable detection and timely treatment to reduce risk of postpartum depression is warranted. Further rigorous research on prenatal depression and adverse birth outcomes is needed