Women may gain the greatest protection for their babies by taking folic acid supplements before getting pregnant, researchers say today.
The study, led by Dr Rachel Morris of Birmingham University, UK, looked at how the timing of folic acid during pregnancy might affect the risk of babies being born small for gestational age (SGA), that is, in the lowest 10% for weight.
The findings will add to the debate about whether basic foods should be enhanced with folic acid.
Figures were taken from 108,525 pregnancies, in which 85% of the mothers had taken folic acid during pregnancy. The average age of the participants was 29 years, and most were non-smokers.
Compared with taking the tablets after conception, pre-conception folic acid was linked to a reduced risk of babies being small(9.9% versus 13.8%). This approach also lowered the risk of being in the lightest 5%, from 7.1% to 4.8%. Taking no folate at all was linked to a raised risk.
Full details of the study are published in BJOG: An International Journal of Obstetrics and Gynaecology.
"It is currently a standard recommendation in the NICE antenatal care guidelines for women to take folic acid supplements before conception and for the first 12 weeks of pregnancy and the Royal College of Obstetricians and Gynaecologists supports this, recommending folic acid to women," said Professor Alan Cameron of the RCOG.
"Previous research has suggested that only around one-third of women take folic acid supplements pre-conceptually," he added. "Therefore, strategies to increase uptake must be evaluated as some women may not plan their pregnancy.
"The RCOG supports a food fortification policy with mandatory fortification of bread or flour with folic acid as a public health measure to improve the lives of both mothers and babies. This will reach women most at risk due to poor dietary habits or socioeconomic status."
The findings were also backed by the UK Royal College of Midwives.
Janet Fyle, from the college, said: "There remains the issue of the large group of childbearing women who do not have access to supplements, particularly vulnerable groups of pregnant women, younger women, ethnic minorities and some women from low socio-economic groups. The figures suggest that at best a third of women take folic acid supplements.
“We need a rethink of policy priorities to ensure that all childbearing women can access folic acid supplementation at the right time."
Hodgetts, V. A. et al. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small for gestational age neonates: A population study, systematic review and meta-analysis. BJOG 26 November 2014 doi: 10.1111/1471-0528.13202
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