British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Maternal folic acid supplement use in early pregnancy and child behavioural problems: The Generation R Study

Sabine J. Rozaa1a2, Tamara van Batenburg-Eddesa1a2, Eric A. P. Steegersa3, Vincent W. V. Jaddoea1a4a5, Johan P. Mackenbacha6, Albert Hofmana5, Frank C. Verhulsta2 and Henning Tiemeiera2a5 c1

a1 The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

a2 Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

a3 Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

a4 Department of Paediatrics, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

a5 Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

a6 Department of Public Health, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

Abstract

Folate deficiency during embryogenesis is an established risk factor for neural tube defects in the fetus. An adequate folate nutritional status is also important for normal fetal growth and brain development. The aim of the present research was to study the association between folic acid use of the mother during pregnancy and child behavioural development. Within a population-based cohort, we prospectively assessed folic acid supplement use during the first trimester by questionnaire. Child behavioural and emotional problems were assessed with the Child Behaviour Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems (OR 1·44; 95 % CI 1·12, 1·86). Folic acid supplement use protected both from internalising (OR of no supplement use 1·65; 95 % CI 1·24, 2·19) and externalising problems (OR 1·45; 95 % CI 1·17, 1·80), even when adjusted for maternal characteristics. Birth weight and size of the fetal head did not mediate the association between folic acid use and child behaviour. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioural problems in the offspring. Folic acid supplementation in early pregnancy, aimed to prevent neural tube defects, may also reduce mental health problems in children.

(Received February 04 2009)

(Revised August 10 2009)

(Accepted August 11 2009)

(Online publication September 22 2009)

Correspondence:

c1 Corresponding author: Dr Henning Tiemeier, fax +31 10 7044657, email h.tiemeier@erasmusmc.nl

Footnotes

Abbreviations: CBCL, Child Behaviour Checklist

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