Folic Acid in Pregnancy May Prevent Language Delay in Kids

Fran Lowry

October 17, 2011

October 17, 2011 — Folic acid supplements taken from 4 weeks before to 8 weeks after conception have been linked to a significantly lower prevalence of severe language delay in children, according to a study published in the October 12 issue of JAMA.

Dr. Christine Roth

"Severe language delay is associated with a range of childhood neuropsychiatric disorders, such as autism, and is also associated with difficulties in achieving literacy," lead author Christine Roth, ClinPsyD, from the Norwegian Institute of Public Health in Oslo, told Medscape Medical News.

Even though half of the children who are rated as having language delay at age 3 years, especially if it is in the moderate range, grow out of it by the time they reach school age, many continue to struggle with language difficulties, said Dr. Roth, who is also a visiting researcher at the Mailman School of Public Health at Columbia University in New York City.

Studies have shown that periconceptional folic acid supplements reduce the risk for neural tube defects, but none of the trials have followed-up to investigate whether the supplements have effects on neurodevelopment that only show after birth, she said.

"Unlike the United States, Norway does not fortify foods with folic acid, increasing the contrast in relative folate status between women who do and do not take folic acid supplements," she noted.

With this in mind, Dr. Roth set out to specifically study periconceptional folic acid use and language delay.

The analysis included 19,956 boys and 18,998 girls born to mothers participating in the Norwegian Mother and Child Cohort Study between 1999 and 2008. The researchers used data on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 2010.

The investigators found that 204 children (0.5%) had severe language delay, defined as minimal expressive language (only 1-word or unintelligible utterances). Of the 9052 children whose mothers took no folic acid supplements, severe language delay was reported in 81 children (0.9%), but among the 7127 children whose mothers did take folic acid supplements, severe language delay was reported in 28 children (0.4%).

"If in future research this relationship were shown to be causal, it would have important implications for understanding the biological processes underlying disrupted neurodevelopment, for the prevention of neurodevelopmental disorders, and for policies of folic acid supplementation for women of reproductive age," senior author Ezra Susser, MD, DrPh, from the Mailman School of Public Health and the New York State Psychiatric Institute, New York City, said in a statement.

Dr. Roth added that Norwegian women should follow the current recommendations of starting to take a folic acid supplement of 0.4 mg daily 1 month before becoming pregnant and continuing through the second to third month of pregnancy.

"This means, of course, that women who might become pregnant should take supplements, so that they will be taking supplements if pregnancy does occur."

However, she stops short of saying that the findings should be used in creating formal policy recommendations.

"Our study does offer some further evidence in favor of the current recommendations, but we caution that it is premature to use it as a basis for formulating policy recommendations," she said.

The study was supported by the Norwegian Ministry of Health and the Ministry of Education and Research, the National Institutes of Health/National Institute of Environmental Health Sciences, and the Norwegian Research Council. Dr. Roth and Dr. Susser have disclosed no relevant financial relationships.

JAMA. 2011; 306:1566-1573. Abstract

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