OMNI

Folic Acid Supplementation

Lead Investigators

Dr. Mark Walker

Dr. Shi Wu Wen

Folic acid supplementation in the first trimester of pregnancy to prevent neural tube defects (NTDs) is unequivocally recommended worldwide. However, many women exceed the recommended dosing and duration of folic acid supplementation in pregnancy. In 2009, the OMNI Research Group received funding to examine whether high-dose folic acid supplementation throughout pregnancy (4-5.1 mg daily) could lower the incidence of preeclampsia among women at high-risk of the syndrome. The findings from Folic Acid Clinical Trial (FACT) have been published:

Wen SW, Rennicks White R, Rybak N, Gaudet LM, Robson S, Hague W, Simms-Stewart D, Carroli G, Smith G, Fraser WD, Wells G, Davidge ST, Kingdom J, Coyle D, Fergusson D, Corsi D, Champagne J, Sabri E, Ramsay T, Willem B, Oudijk M, Walker MC, FACT Collaborating Group. Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. BMJ. 2018; 362:k347812 2018. doi: 10.1136/bmj.k3478

We are now conducting additional analyses on FACT data to evaluate the effect of high-dose folic acid supplementation on risk of pre-eclampsia among specific sub-populations (e.g. diabetes, obesity). The global variations in other medication use in pregnancy and their association with obstetrical and neonatal outcomes in this unique, high-risk population are also being examined.

In addition, our new FACT 4 Child study is examining the effect of folic acid supplementation in pregnancy on the risk of social impairments, executive function, emotional and behavioural problems, and death through prospective follow-up of children born to women who participated in FACT.

Funding:

An epidemiologic research program to improve maternal and child health. Canadian Institutes of Health Research. Foundation Grant. Principal Applicants: Walker MC, Wen SW. ($9,876,973)(2016-2022)
Effect of folic acid supplementation in pregnancy on preeclampsia. Canadian Institutes of Health Research. Randomized Controlled Trials. Principal Applicant: Wen SW. ($6,413,579) (2010-2015)

Select Publications:

1. Corsi DJ, Gaudet LM, El-Chaar D, White RR, Rybak N, Harvey A, Muldoon K, Wen SW, Walker M. Effect of high-dose folic acid supplementation on the prevention of preeclampsia in twin pregnancy. J Matern Fetal Neonatal Med. 2022;35(3):503-508. doi: 10.1080/14767058.2020.1725882.

2. Murphy MSQ, Muldoon KA, Sheyholislami H, Behan N, Lamers Y, Rybak N, White RR, Harvey ALJ, Gaudet LM, Smith GN, Walker MC, Wen SW, MacFarlane AJ. Impact of high-dose folic acid supplementation in pregnancy on biomarkers of folate status and 1-carbon metabolism: An ancillary study of the Folic Acid Clinical Trial (FACT). American Journal of Clinical Nutrition. 2021; 113(5):1361-1371. doi: 10.1093/ajcn/nqaa407.

3. Rose EG, Murphy MSQ, Erwin E, Muldoon KA, Harvey ALJ, Rennicks White R, MacFarlane AJ, Wen SW, Walker MC.
Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia. Journal of Nutrition. 2021; 151(7):1976-1982. doi: 10.1093/jn/nxab063

4. Guo Y, Luo R, Corsi DJ, Rennicks White R, Smith G, Rodger M, Retnakaran R, Walker M, Wen SW. Folic Acid Supplementation in Early Pregnancy, Homocysteine Concentration and Risk of Gestational Diabetes Mellitus. Journal of Obstetrics and Gynaecology Canada. 2022; 44(2):196-199. doi: 10.1016/j.jogc.2021.06.005

Actively Recruiting Research Studies

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The FACT 4 Child study is examining the effect of folic acid supplementation in pregnancy on the risk of social impairments, executive function, emotional and behavioural problems, and death through prospective follow-up of children born to women who participated in FACT (see above).